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Stevenson TB, Thapaliya K, Moore V, Mazza D, Grzeskowiak LE. Accessibility of oral emergency contraceptives in Australian community pharmacies. Contraception 2024:110480. [PMID: 38710355 DOI: 10.1016/j.contraception.2024.110480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 04/25/2024] [Accepted: 04/29/2024] [Indexed: 05/08/2024]
Abstract
OBJECTIVES To assess the availability of over-the-counter emergency contraceptive pills in the Australian community pharmacy setting. STUDY DESIGN Representative national telephone survey. RESULTS Only 70% of the 233 pharmacies surveyed stocked ulipristal acetate (UPA) emergency contraceptive pills, compared to levonorgestrel, which was stocked in 98%. When ulipristal acetate was stocked, it was on average $13 more expensive. CONCLUSIONS Despite being recommended as the first-line oral emergency contraceptive, UPA is less likely to be available, and when available, it is likely to be more expensive. These findings support anecdotal reports UPA is challenging to access and less commonly used. IMPLICATIONS Strategies are urgently required to improve equitable access to all methods of oral emergency contraception within the Australian community pharmacy setting and ensure pharmacists are aware of key differences between the available methods. This will ensure that they are prepared to facilitate shared decision making based on the individual needs of each woman.
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Affiliation(s)
- Tahlee B Stevenson
- School of Public Health, Faculty of Health and Medical Science, University of Adelaide, Adelaide, South Australia, Australia
| | - Kailash Thapaliya
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Vivienne Moore
- School of Public Health, Faculty of Health and Medical Science, University of Adelaide, Adelaide, South Australia, Australia
| | - Danielle Mazza
- Department of General Practice, Monash University, Notting Hill, Victoria, Australia
| | - Luke E Grzeskowiak
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia; SAHMRI Women and Kids, Level 7, Clarence Rieger Building, Women's and Children's Hospital, North Adelaide, South Australia, Australia.
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2
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Yi H, Stamm CA, Wright G, Mondie WS, Rupp L, Borgelt L. Emergency contraception in a historic southern city: Mystery caller study in Birmingham, Alabama. Contraception 2024; 132:110361. [PMID: 38160962 DOI: 10.1016/j.contraception.2023.110361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 12/18/2023] [Accepted: 12/22/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Alabama's Human Life Protection Act (the Act) signed in 2019 became law in 2022, making provision of abortion a felony offense. OBJECTIVE In 2020, we assessed the accessibility of emergency contraception (EC) pills in Birmingham, Alabama prior to the Act's enactment given the probable increased need for EC access due to abortion criminalization. STUDY DESIGN Pharmacy staff were asked about availability, price, location, and identification requirements to obtain EC. RESULTS Of 69 pharmacies, 59% had levonorgestrel EC and none had ulipristal acetate EC available. CONCLUSION There are persistent barriers to EC accessibility that should be addressed as abortion is increasingly restricted.
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Affiliation(s)
- Heami Yi
- University of Colorado Anschutz Medical Campus School of Medicine, Aurora, CO, USA.
| | - Carol A Stamm
- University of Colorado Anschutz Medical Campus, Department of Medicine, Aurora, CO, USA
| | - Garth Wright
- University of Colorado Anschutz Medical Campus, Departments of Clinical Pharmacy and Family Medicine, Aurora, CO, USA
| | - Wei-San Mondie
- Denver Health Medical Center, Department of Family Medicine, Denver, CO, USA
| | - Leanne Rupp
- National Association of Social Workers, Colorado Chapter, Denver, CO, USA
| | - Laura Borgelt
- University of Colorado Anschutz Medical Campus, Departments of Clinical Pharmacy and Family Medicine, Aurora, CO, USA
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3
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Gawron LM, Kaiser JE, Gero A, Sanders JN, Johnstone EB, Turok DK. Pharmacodynamic evaluation of the etonogestrel contraceptive implant initiated midcycle with and without ulipristal acetate: An exploratory study. Contraception 2024; 132:110370. [PMID: 38232940 PMCID: PMC10922844 DOI: 10.1016/j.contraception.2024.110370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 01/19/2024]
Abstract
OBJECTIVE To estimate the incidence of ovulation suppression within five days of etonogestrel 68 mg implant insertion in the presence of a dominant follicle with and without same-day ulipristal acetate. STUDY DESIGN This single site non-masked, exploratory randomized trial recruited people age 18-35 years with regular menstrual cycles, no pregnancy risk, and confirmed ovulatory function. We initiated transvaginal ultrasound examinations on menstrual day 7-9 and randomized participants 1:1 to etonogestrel implant alone or with concomitant ulipristal acetate 30 mg oral when a dominant follicle reached ≥14 mm in diameter. We completed daily sonography and serum hormone levels for up to seven days or transitioned to labs alone if sonographic follicular rupture occurred. We defined ovulation as follicular rupture followed by progesterone >3 ng/mL. We calculated point estimates, risk ratios and 95% confidence intervals for ovulation for each group. Ovulation suppression of ≥44% in either group (the follicular rupture suppression rate with oral levonorgestrel emergency contraception), would prompt future method testing. RESULTS From October 2020 to October 2022, we enrolled 40 people and 39 completed primary outcome assessments: 20 with etonogestrel implant alone (mean follicular size at randomization: 15.2 mm ± 0.9 mm) and 19 with etonogestrel implant + ulipristal acetate (mean follicular size at randomization: 15.4 mm ± 1.2 mm, p = 0.6). Ovulation suppression occurred in 13 (65%) of etonogestrel implant-alone participants (Risk ratio 0.6 (95% CI: 0.3, 1.1), p = 0.08) and seven (37%) of implant + ulipristal acetate participants. CONCLUSIONS Ovulation suppression of the etonogestrel implant alone exceeds threshold testing for future research while the implant + ulipristal acetate does not. IMPLICATIONS Data are lacking on midcycle ovulation suppression for the etonogestrel implant with and without oral ulipristal acetate. In this exploratory study, ovulation suppression occurred in 65% of implant participants and 37% of implant + ulipristal acetate participants. Ovulation suppression of the implant alone exceeds threshold testing for future emergency contraception research.
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Affiliation(s)
- Lori M Gawron
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA.
| | - Jennifer E Kaiser
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA
| | - Alexandra Gero
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA
| | - Jessica N Sanders
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA
| | - Erica B Johnstone
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA
| | - David K Turok
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA
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4
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Hirano M, Wada-Hiraike O, Fukui M, Shibata S, Uehara M, Nagumo A, Urata Y, Sone K, Harada M, Koga K, Osuga Y. Ulipristal (UPA) effects on rat ovaries: Unraveling follicle dynamics, ovulation inhibition, and safety implications for prolonged use. Reprod Toxicol 2024; 125:108571. [PMID: 38458359 DOI: 10.1016/j.reprotox.2024.108571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/22/2024] [Accepted: 03/04/2024] [Indexed: 03/10/2024]
Abstract
Ulipristal (UPA), a selective progesterone receptor modulator, has both agonistic and antagonistic effects on progesterone receptors. UPA suppresses ovulation by inhibiting the luteinizing hormone (LH) surge from the pituitary gland; however, the direct effect of UPA on ovarian tissue remains poorly studied. In the present study, we examined the effects of UPA on the ovaries of rats. Rats were treated for 28 days with UPA, and the effects of UPA on ovarian tissue were examined histologically and the expression of antioxidant genes and cell death markers were also investigated. UPA treatment increased the number of primordial follicles at each treatment group, primordial follicles increased at all dose levels, but the size/magnitude of the effect decreased with the increasing dose. The number of primary and antral follicles tended to increase with increasing UPA levels. Furthermore, the decrease in primary follicle number could be attributed to the exhaustion of follicles, but the examination of proliferation markers, oxidative stress markers, and cell death markers revealed no remarkable toxic effects on ovarian tissues. These results suggest that UPA treatment promotes follicle development at each stage but inhibits ovulation by suppressing the LH surge, resulting in an increase in atretic follicles or unruptured luteinized cysts. These results suggest that UPA may not have both toxic effects on the ovary and a direct local effect on ovarian follicles, but we should be careful about the effects of prolonged UPA treatment in patients with uterine fibroids on their future fecundity.
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Affiliation(s)
- Mana Hirano
- Department of Obstetrics and Gynecology, Graduate school of Medicine, The University of Tokyo, Tokyo 1138655, Japan; Department of Obstetrics and Gynecology, Teikyo University, Tokyo 1738606, Japan
| | - Osamu Wada-Hiraike
- Department of Obstetrics and Gynecology, Graduate school of Medicine, The University of Tokyo, Tokyo 1138655, Japan.
| | | | | | - Mari Uehara
- Department of Obstetrics and Gynecology, Graduate school of Medicine, The University of Tokyo, Tokyo 1138655, Japan
| | - Aiko Nagumo
- Department of Obstetrics and Gynecology, Graduate school of Medicine, The University of Tokyo, Tokyo 1138655, Japan
| | - Yoko Urata
- Department of Obstetrics and Gynecology, Graduate school of Medicine, The University of Tokyo, Tokyo 1138655, Japan
| | - Kenbun Sone
- Department of Obstetrics and Gynecology, Graduate school of Medicine, The University of Tokyo, Tokyo 1138655, Japan
| | - Miyuki Harada
- Department of Obstetrics and Gynecology, Graduate school of Medicine, The University of Tokyo, Tokyo 1138655, Japan
| | - Kaori Koga
- Department of Obstetrics and Gynecology, Graduate school of Medicine, The University of Tokyo, Tokyo 1138655, Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, Graduate school of Medicine, The University of Tokyo, Tokyo 1138655, Japan
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5
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Gawron LM, Sexsmith CD, Carter G, Kaiser JE, Pangasa M, Turok DK. Efficacy of oral levonorgestrel emergency contraception with same day etonogestrel contraceptive implant: A prospective observational study. Contraception 2024; 131:110344. [PMID: 38008305 PMCID: PMC10872399 DOI: 10.1016/j.contraception.2023.110344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 11/28/2023]
Abstract
OBJECTIVE To determine a 1-month pregnancy rate point estimate and 95% confidence interval for guideline-supported, same-day initiation of an etonogestrel implant plus oral levonorgestrel emergency contraception. STUDY DESIGN In this single-arm, prospective observational study, all emergency contraception clients who presented to four Planned Parenthood Association of Utah clinics from February 2021 to March 2023 received information about oral levonorgestrel with same-day etonogestrel implant insertion. Participants were ≤35 years and reported unprotected intercourse within 5 days with negative pregnancy testing. The primary outcome measure was a 1-month home pregnancy test. We calculated the efficacy using a test of proportions with Yates continuity correction. RESULTS A total of 160 emergency contraception clients (7.6% of 2106 approached) enrolled and 153 had 1-month pregnancy outcomes. A positive pregnancy test occurred in 2 participants resulting in an overall pregnancy rate of 1.32% (95% confidence interval 0.23%-5.19%). Ultrasound gestational dating assigned conception of the first pregnancy to 8 days before enrollment. For the second pregnancy, ultrasound dating designated conception at 5 days prior to enrollment. Limiting the efficacy rate to the single pregnancy that occurred within 5 days of unprotected intercourse, we report a pregnancy rate of 0.66% (95% confidence interval 0.03%-4.19%). CONCLUSIONS In this observational study of emergency contraception clients selecting oral levonorgestrel with same-day etonogestrel implant, we identified a pregnancy rate within the established range of oral emergency contraception methods alone. IMPLICATIONS Clients presenting for emergency contraception may also desire ongoing highly-effective contraception, yet current clinical guidelines serve as a barrier to same-day method initiation for the etonogestrel implant and other hormonal methods. Improving access to contraceptive method initiation will reduce the ongoing risk of unwanted pregnancy for this population. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov NCT04678817; registered 12/16/20.
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Affiliation(s)
- Lori M Gawron
- ASCENT Center for Reproductive Health, Family Planning Division, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, United States.
| | - Corinne D Sexsmith
- ASCENT Center for Reproductive Health, Family Planning Division, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Gentry Carter
- ASCENT Center for Reproductive Health, Family Planning Division, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Jennifer E Kaiser
- ASCENT Center for Reproductive Health, Family Planning Division, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Misha Pangasa
- ASCENT Center for Reproductive Health, Family Planning Division, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - David K Turok
- ASCENT Center for Reproductive Health, Family Planning Division, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, United States
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6
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Torres E, Carter G, Gero A, Simmons RG, Sanders JN, Turok DK. Frequency of same-day contraceptive initiation, recent unprotected intercourse, and pregnancy risk: a prospective cohort study of multiple contraceptive methods. Am J Obstet Gynecol 2024:S0002-9378(24)00083-8. [PMID: 38367756 DOI: 10.1016/j.ajog.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 02/01/2024] [Accepted: 02/09/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Same-day start removes barriers to contraceptive initiation and may reduce the risk of unintended pregnancy. It may be appropriate for all contraceptive methods, but we lack data comparing methods. OBJECTIVE This study aimed to assess the frequency of same-day start with 6 contraceptive methods among new contraceptive users and describe the efficacy of same-day start in terms of first-cycle pregnancy risk overall and by each method. STUDY DESIGN Using prospective data from the HER Salt Lake Contraceptive Initiative, we identified and assessed outcomes for participants initiating a new method of contraception beyond the first 7 days of their menstrual cycle (same-day start). Enrolled participants at 4 family planning clinics in Salt Lake County, Utah between September 2015 and March 2017 received their method of choice regardless of their cycle day or recent unprotected intercourse. All participants self-reported last menstrual period data and unprotected intercourse events in the previous 2 weeks. We excluded participants who received care immediately after or within 2 weeks of abortion care. Clinical electronic health records provided information on contraceptive method initiation and use of oral emergency contraception. Participants reported pregnancy outcomes in 1-, 3-, and 6-month follow-up surveys with clinic verification to identify any pregnancy resulting from same-day initiation. The primary outcomes report the frequency of same-day start use and first-cycle pregnancy risk among same-day start users of all contraceptive methods. The secondary outcomes include frequency of and pregnancy risk in the first cycle of use among same-day start contraception users by method. We also report the frequency of unprotected intercourse within 5 days and 6 to 14 days of contraception initiation, frequency of concomitant receipt of oral emergency contraception with initiation of ongoing contraception, and pregnancy risk with these exposures. We analyzed pregnancy risk for each contraceptive method initiated on the same day and assessed the simultaneous use of oral emergency contraception. RESULTS Of the 3568 individuals enrolled, we identified most as same-day start users (n=2575/3568; 72.2%), with 1 in 8 of those reporting unprotected intercourse in the previous 5 days (n=322/2575; 12.5%) and 1 in 10 reporting unprotected intercourse 6 to 14 days before contraceptive method initiation (n=254/2575; 9.9%). We identified 11 pregnancies among same-day start users (0.4%; 95% confidence interval, 0.2-0.7), as opposed to 1 (0.1%; 95% confidence interval, 0.002-0.6) among those who initiated contraception within 7 days from the last menstrual period. Users of oral hormonal contraception and vaginal hormonal methods reported the highest first-cycle pregnancy rates (1.0-1.2). Among same-day start users, 174 (6.8%) received oral emergency contraception at enrollment in conjunction with another method. Among the same-day start users who received emergency contraception at initiation, 4 (2.3%) pregnancies were reported. CONCLUSION Same-day start is common and associated with a low pregnancy risk. Using the "any method, any-time" approach better meets contraceptive clients' needs and maintains a low risk of pregnancy.
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Affiliation(s)
- Erica Torres
- Division of Family Planning, Department of Obstetrics and Gynecology, The University of Utah, Salt Lake City, UT.
| | - Gentry Carter
- Division of Family Planning, Department of Obstetrics and Gynecology, The University of Utah, Salt Lake City, UT
| | - Alexandra Gero
- Division of Family Planning, Department of Obstetrics and Gynecology, The University of Utah, Salt Lake City, UT
| | - Rebecca G Simmons
- Division of Family Planning, Department of Obstetrics and Gynecology, The University of Utah, Salt Lake City, UT
| | - Jessica N Sanders
- Division of Family Planning, Department of Obstetrics and Gynecology, The University of Utah, Salt Lake City, UT
| | - David K Turok
- Division of Family Planning, Department of Obstetrics and Gynecology, The University of Utah, Salt Lake City, UT
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7
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Ramanadhan S, Jensen J. The Levonorgestrel-Releasing Intrauterine Device as Emergency Contraception: Re-examining the Data. Obstet Gynecol 2024; 143:189-194. [PMID: 37989139 DOI: 10.1097/aog.0000000000005466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/14/2023] [Indexed: 11/23/2023]
Abstract
Emergency contraception methods that also deliver ongoing contraception provide the most effective options for individuals hoping to prevent pregnancy after unprotected intercourse. Although the copper intrauterine device (IUD) provides the most effective option for emergency contraception because the device prevents pregnancy when placed before implantation and offers long-acting contraception, uptake by patients has been limited. Recently, the Society of Family Planning issued new guidance recommending the levonorgestrel IUD (LNG-IUD) as an emergency contraception option along with the copper IUD. Here, we review evidence related to this recommendation and conclude that the available data do not support use of the LNG-IUD for emergency contraception. We discuss the mechanisms of action of emergency contraception methods and how these concepts interface with the current political and social landscape of contraception and abortion care. We describe limitations of the existing evidence supporting use of the LNG-IUD as emergency contraception and highlight the critical research needed to establish the device as a highly effective method of emergency contraception.
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Affiliation(s)
- Shaalini Ramanadhan
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon
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8
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Garriga M, Zhang G, Sarkar M. Contraception in patients with liver disease and liver transplant. Clin Liver Dis (Hoboken) 2024; 23:e0104. [PMID: 38379765 PMCID: PMC10878548 DOI: 10.1097/cld.0000000000000104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 09/30/2023] [Indexed: 02/22/2024] Open
Abstract
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Affiliation(s)
- Meera Garriga
- Department of Medicine University of California, San Francisco, San Francisco, CA, USA
| | - Grace Zhang
- Department of Medicine University of California, San Francisco, San Francisco, CA, USA
| | - Monika Sarkar
- Division of GI/Hepatology, University of California, San Francisco, San Francisco, CA, USA
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9
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Rudzinski P, Lopuszynska I, Pazik D, Adamowicz D, Jargielo A, Cieslik A, Kosieradzka K, Stanczyk J, Meliksetian A, Wosinska A. Emergency contraception - A review. Eur J Obstet Gynecol Reprod Biol 2023; 291:213-218. [PMID: 37922775 DOI: 10.1016/j.ejogrb.2023.10.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 10/21/2023] [Accepted: 10/30/2023] [Indexed: 11/07/2023]
Abstract
Emergency contraception (EC), or postcoital contraception, is a therapy aimed at preventing unintended pregnancy after an act of unprotected or under-protected sexual intercourse. Options include both emergency contraceptive pills (most commonly containing levonorgestrel or ulipristal acetate) and insertion of an intrauterine device. The aim of this paper is to summarize current evidence surrounding the use of emergency contraceptives and to present an evidence-based approach to EC provision. Emergency contraception is a safe and effective option in preventing unwanted pregnancy, irrespective of age, weight, or breastfeeding status. Efforts should be made to increase their availability, as well as knowledge of these methods, both among patients and healthcare providers.
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Affiliation(s)
- Patryk Rudzinski
- Independent Public Clinical Hospital Named After Prof. W. Orłowski of the Centre for Postgraduate Medical Education, Warsaw, Poland.
| | - Inga Lopuszynska
- The National Institute of Medicine of the Ministry of Interior and Administration, Warsaw, Poland
| | - Dorota Pazik
- Independent Public Clinical Hospital Named After Prof. W. Orłowski of the Centre for Postgraduate Medical Education, Warsaw, Poland
| | - Dominik Adamowicz
- University Clinical Centre of the Medical University of Warsaw, Warsaw, Poland
| | - Anna Jargielo
- Military Institute of Medicine - National Research Institute, Warsaw, Poland
| | | | | | - Justyna Stanczyk
- National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Astrik Meliksetian
- The National Institute of Medicine of the Ministry of Interior and Administration, Warsaw, Poland
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10
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Belail Hammad WA, Gupta N, Konje JC. An overview of contraception in women with obesity. Best Pract Res Clin Obstet Gynaecol 2023; 91:102408. [PMID: 37683520 DOI: 10.1016/j.bpobgyn.2023.102408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 08/08/2023] [Accepted: 08/14/2023] [Indexed: 09/10/2023]
Abstract
The use of safe and effective contraception is essential for preventing unplanned pregnancy in women of all body sizes. When counseling women with obesity about contraception, it is important to consider the pharmacokinetic alterations of obesity on various modern contraceptive methods. However, evidence is reassuring that most contraceptive methods are safe and effective in women with obesity. Individual countries and the World Health Organization have published Medical Eligibility Criteria to guide contraceptive selection in women with medical issues including obesity. When choosing contraception, specific risks of the method relative to any underlying medical disorders must also be balanced against the risks of unintended pregnancy in this group.
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Affiliation(s)
- Wafaa Ali Belail Hammad
- Specialist Registrar, Department of Obstetrics & Gynaecology, Basildon and Thurrock University Hospitals NHS Foundation Trust, UK.
| | - Neerja Gupta
- Consultant Obstetrician and Gynaecologist, Basildon and Thurrock University Hospitals NHS Foundation Trust, UK
| | - Justin C Konje
- Senior Consultant Obstetrician and Gynaecologist, Feto Maternal Centre, Professor of Obstetrics and Gynecology, Weill Cornell Medicine, Qatar and Emeritus Professor of Obstetrics and Gynaecology, Department of Health Sciences, University of Leicester, UK
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11
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Shihab S, Vegunta S, Cheney M. Emergency Contraception at a Glance: How to Provide Counseling for Patients. J Womens Health (Larchmt) 2023; 32:1281-1283. [PMID: 37389832 DOI: 10.1089/jwh.2023.0372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023] Open
Affiliation(s)
- Sara Shihab
- Division of Women's Health-Internal Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | - Suneela Vegunta
- Division of Women's Health-Internal Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | - Megan Cheney
- Obstetrics and Gynecology, Mayo Clinic, Scottsdale, Arizona, USA
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12
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Li RHW, Lo SST, Gemzell-Danielsson K, Fong CHY, Ho PC, Ng EHY. Oral emergency contraception with levonorgestrel plus piroxicam: a randomised double-blind placebo-controlled trial. Lancet 2023; 402:851-858. [PMID: 37597523 DOI: 10.1016/s0140-6736(23)01240-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/22/2023] [Accepted: 06/13/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Levonorgestrel, a standard drug for emergency contraception (EC), is not effective if administered post-ovulation. A cyclo-oxygenase inhibitor could contribute synergistic effects. We investigated whether a single 40 mg oral dose of piroxicam as co-treatment with levonorgestrel improved emergency contraceptive efficacy. METHODS This was a randomised double-blind placebo-controlled trial carried out in a major community sexual and reproductive health service in Hong Kong. Women who required levonorgestrel EC within 72 h of unprotected sexual intercourse were recruited and block-randomised in a 1:1 ratio to receive a single supervised dose of levonorgestrel 1·5 mg plus either piroxicam 40 mg or placebo orally. Group assignment was concealed in opaque envelopes and masked to the women, clinicians, and investigators. At follow-up 1-2 weeks after the next expected period, the pregnancy status was noted by history or pregnancy test. The primary efficacy outcome was the proportion of pregnancies prevented out of those expected based on an established model. All women randomised to receive the study drug and who completed the follow-up were analysed. The trial was registered with ClinicalTrials.gov, NCT03614494. FINDINGS 860 women (430 in each group) were recruited between Aug 20, 2018, and Aug 30, 2022. One (0·2%) of 418 efficacy-eligible women in the piroxicam group were pregnant, compared with seven (1·7%) of 418 in the placebo group (odds ratio 0·20 [95% CI 0·02-0·91]; p=0·036). Levonorgestrel plus piroxicam prevented 94·7% of expected pregnancies compared with 63·4% for levonorgestrel plus placebo. We noted no significant difference between the two groups in the proportion of women with advancement or delay of their next period, or in the adverse event profile. INTERPRETATION Oral piroxicam 40 mg co-administered with levonorgestrel improved efficacy of EC in our study. Piroxicam co-administration could be considered clinically where levonorgestrel EC is the option of choice. FUNDING None.
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Affiliation(s)
- Raymond Hang Wun Li
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; The Family Planning Association of Hong Kong, Hong Kong Special Administrative Region, China.
| | - Sue Seen Tsing Lo
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; The Family Planning Association of Hong Kong, Hong Kong Special Administrative Region, China
| | - Kristina Gemzell-Danielsson
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Carol Ho Yi Fong
- Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Pak Chung Ho
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; The Family Planning Association of Hong Kong, Hong Kong Special Administrative Region, China
| | - Ernest Hung Yu Ng
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; The Family Planning Association of Hong Kong, Hong Kong Special Administrative Region, China
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13
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Cahill EP. Adding a COX-2 inhibitor improves efficacy of emergency contraception. Lancet 2023; 402:826-827. [PMID: 37597526 DOI: 10.1016/s0140-6736(23)01612-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/01/2023] [Indexed: 08/21/2023]
Affiliation(s)
- Erica P Cahill
- Department of Obstetrics and Gynecology, Division of Family Planning Services and Research, Stanford University School of Medicine, Stanford, CA 94305-5101, USA.
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Yesodharan R, Kamath P, Renjith V, Krishnan NM, Senarathne UD, Sasidharan SK, Jose TT, Nayak VC. The role of legal medicine professionals in preventing pregnancy and sexually transmitted infections among female victims of sexual assault. Forensic Sci Med Pathol 2023; 19:440-451. [PMID: 36881378 PMCID: PMC10518277 DOI: 10.1007/s12024-023-00578-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2023] [Indexed: 03/08/2023]
Abstract
Sexual violence can have an overwhelming impact on the victim's physical and mental health; the consequences include unintended pregnancy and sexually transmitted infections (STIs). Therefore, the examiners must assess victims for possible pregnancy and sexually transmitted infections as a part of the sexual assault examination. This article aims to orient the medico-legal examiners towards their role in preventing unintended pregnancy and sexually transmitted infections among victims of sexual assault. Prompt detection of pregnancy or STIs is critical, as any delay would adversely affect the successful administration of emergency contraception and post-exposure prophylaxis (PEP) against human immunodeficiency virus (HIV) and other sexually transmitted infections.
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Affiliation(s)
- Renjulal Yesodharan
- Department of Psychiatric Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka India
| | - Pratibha Kamath
- Department of OBG Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka India
| | - Vishnu Renjith
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland, 123 St Stephen’s Green, Dublin 2, Ireland
| | - Nirmal M. Krishnan
- Department of Forensic Medicine and Toxicology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka India
| | - Udara Dilrukshi Senarathne
- Faculty of Medical Sciences, Department of Biochemistry, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Suja Kumari Sasidharan
- Department of Obstetrics and Gynaecological Nursing, Amrita College of Nursing, Amrita Vishwa Vidyapeetham, Ernakulum, Kerala India
| | - Tessy Treesa Jose
- Department of Psychiatric Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka India
| | - Vinod C. Nayak
- Department of Forensic Medicine and Toxicology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka India
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15
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Downing NR, Avshman E, Valentine JL, Johnson LM, Chapa H. Forensic Nurses' Understanding of Emergency Contraception Mechanisms: Implications for Access to Emergency Contraception. JOURNAL OF FORENSIC NURSING 2023; 19:150-159. [PMID: 37590937 DOI: 10.1097/jfn.0000000000000430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND An estimated 25,000 pregnancies result from sexual assault in the United States annually. Numerous professional healthcare organizations endorse offering emergency contraception (EC) as an integrated aspect of post-sexual-assault care. Lack of knowledge surrounding EC's mechanism of action, including misinterpreting ECs as abortifacients, might restrict patient access to this important healthcare option. PURPOSE We evaluated sexual assault nurse examiners' understanding of the mechanism of action of oral ECs levonorgestrel (LNG) and ulipristal acetate (UPA). METHODS A cross-sectional survey of practicing sexual assault nurse examiners was conducted through the International Association of Forensic Nurses. RESULTS Among 173 respondents, 96.53% reported they prescribed/dispensed EC at the time of medical forensic examinations. LNG was prescribed more frequently than UPA (57.80% vs. 38.2%, respectively). When asked if they agreed or disagreed if LNG and UPA can disrupt an established pregnancy, 83.2% selected disagree/strongly disagree for LNG versus 78.6% for UPA, which were not significantly different. When asked whether the Supreme Court ruling overturning Roe v. Wade would change their EC prescribing, 79.77% reported it will have no change, 6.94% said it would increase, and 12.72% reported they were unsure. Several commented they were concerned whether state laws would prohibit EC and at least one program stopped prescribing EC because of their state laws. IMPLICATIONS Addressing misinformation regarding EC's mechanism of action and increasing access to oral EC options after sexual assault have the potential to reduce the incidence of rape-related pregnancy.
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Affiliation(s)
- Nancy R Downing
- Author Affiliations: School of Nursing, Texas A&M University
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16
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Sapapsap B, Leelakanok N, Boonpattharatthiti K, Siritientong T, Methaneethorn J. A systematic review and meta-analysis of the prevalence and association between levonorgestrel and ectopic pregnancy. Expert Opin Drug Saf 2023; 22:929-941. [PMID: 37577925 DOI: 10.1080/14740338.2023.2247965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 07/12/2023] [Accepted: 08/09/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND The use of levonorgestrel emergency oral contraceptives (EOCs) is one of the factors that may be associated with ectopic pregnancy. We aimed to investigate the incidence of ectopic pregnancy in EOC users and the association between EOCs and ectopic pregnancy. RESEARCH DESIGN AND METHODS We searched for articles that provided the incidence of and the association between levonorgestrel EOCs and ectopic pregnancy in women of reproductive ages in CINAHL Complete, Medline, OpenDissertations, Scopus, Science Direct, and Thai Journal Online. The risk of bias was assessed by Risk Of Bias In Non-randomized Studies or Risk of Bias 2. A meta-analysis was conducted using the random-effects model. RESULTS We retrieved 1839 nonredundant articles from the systematic search. The meta-analysis showed that the prevalence of ectopic pregnancy was not statistically different from zero (pooled prevalence estimate = 0.029%; 95%CI: -0.006, 0.065; N = 9; I2 = 0) and rare. In addition, levonorgestrel EOCs increased the risk of ectopic pregnancy (OR = 6.17; 95%CI: 3.78, 10.08; N = 5; I2 = 43%). CONCLUSIONS Women with extrauterine or ectopic pregnancy had higher odds of using levonorgestrel emergency oral contraceptives than those with intrauterine pregnancy. However, the prevalence of ectopic pregnancy is rare.
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Affiliation(s)
- Bannawich Sapapsap
- Division of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Burapha University, Chonburi, Thailand
| | - Nattawut Leelakanok
- Division of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Burapha University, Chonburi, Thailand
| | - Kansak Boonpattharatthiti
- Division of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Burapha University, Chonburi, Thailand
| | - Tippawan Siritientong
- Department of Food and Pharmaceutical Chemistry, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Janthima Methaneethorn
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
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17
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Cameron S, Li HWR, Gemzell-Danielsson K. Is contragestion the future? BMJ SEXUAL & REPRODUCTIVE HEALTH 2023:bmjsrh-2022-201758. [PMID: 36805893 DOI: 10.1136/bmjsrh-2022-201758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 02/09/2023] [Indexed: 06/18/2023]
Affiliation(s)
- Sharon Cameron
- Chalmers Sexual Health Centre, Edinburgh, UK
- Section of Obstetrics and Gynaecology, The University of Edinburgh, Edinburgh, UK
| | - Hang Wun Raymond Li
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Pokfulam, Hong Kong
- The Family Planning Association of Hong Kong, Wan Chai, Hong Kong
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18
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Dotts AJ, Reiman D, Yin P, Kujawa S, Grobman WA, Dai Y, Bulun SE. In Vivo Genome-Wide PGR Binding in Pregnant Human Myometrium Identifies Potential Regulators of Labor. Reprod Sci 2023; 30:544-559. [PMID: 35732928 PMCID: PMC9988762 DOI: 10.1007/s43032-022-01002-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/03/2022] [Indexed: 12/22/2022]
Abstract
The alterations in myometrial biology during labor are not well understood. The myometrium is the contractile portion of the uterus and contributes to labor, a process that may be regulated by the steroid hormone progesterone. Thus, human myometrial tissues from term pregnant in-active-labor (TIL) and term pregnant not-in-labor (TNIL) subjects were used for genome-wide analyses to elucidate potential future preventive or therapeutic targets involved in the regulation of labor. Using myometrial tissues directly subjected to RNA sequencing (RNA-seq), progesterone receptor (PGR) chromatin immunoprecipitation sequencing (ChIP-seq), and histone modification ChIP-seq, we profiled genome-wide changes associated with gene expression in myometrial smooth muscle tissue in vivo. In TIL myometrium, PGR predominantly occupied promoter regions, including the classical progesterone response element, whereas it bound mainly to intergenic regions in TNIL myometrial tissue. Differential binding analysis uncovered over 1700 differential PGR-bound sites between TIL and TNIL, with 1361 sites gained and 428 lost in labor. Functional analysis identified multiple pathways involved in cAMP-mediated signaling enriched in labor. A three-way integration of the data for ChIP-seq, RNA-seq, and active histone marks uncovered the following genes associated with PGR binding, transcriptional activation, and altered mRNA levels: ATP11A, CBX7, and TNS1. In vitro studies showed that ATP11A, CBX7, and TNS1 are progesterone responsive. We speculate that these genes may contribute to the contractile phenotype of the myometrium during various stages of labor. In conclusion, we provide novel labor-associated genome-wide events and PGR-target genes that can serve as targets for future mechanistic studies.
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Affiliation(s)
- Ariel J Dotts
- Department of Obstetrics & Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Derek Reiman
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - Ping Yin
- Department of Obstetrics & Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Stacy Kujawa
- Department of Obstetrics & Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - William A Grobman
- Department of Obstetrics & Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Yang Dai
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - Serdar E Bulun
- Department of Obstetrics & Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA.
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19
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Salcedo J, Cleland K, Bartz D, Thompson I. Society of Family Planning Clinical Recommendation: Emergency contraception. Contraception 2023; 121:109958. [PMID: 36693445 DOI: 10.1016/j.contraception.2023.109958] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/30/2022] [Accepted: 01/10/2023] [Indexed: 01/22/2023]
Abstract
Emergency contraception (EC) refers to several contraceptive options that can be used within a few days after unprotected or under protected intercourse or sexual assault to reduce the risk of pregnancy. Current EC options available in the United States include the copper intrauterine device (IUD), levonorgestrel (LNG) 52 mg IUD, oral LNG (such as Plan B One-Step, My Way, Take Action), and oral ulipristal acetate (UPA) (ella). These clinical recommendations review the indications, effectiveness, safety, and side effects of emergency contraceptive methods; considerations for the use of EC by specific patient populations and in specific clinical circumstances and current barriers to emergency contraceptive access. Further research is needed to evaluate the effectiveness of LNG IUDs for emergency contraceptive use; address the effects of repeated use of UPA at different times in the same menstrual cycle; assess the impact on ovulation of initiating or reinitiating different regimens of regular hormonal contraception following UPA use; and elucidate effective emergency contraceptive pill options by body mass indices or weight.
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Affiliation(s)
- Jennifer Salcedo
- Department of Obstetrics and Gynecology, New York Medical College, Valhalla, NY, United States.
| | - Kelly Cleland
- American Society for Emergency Contraception, Lawrenceville, NJ, United States
| | - Deborah Bartz
- Department of Obstetrics and Gynecology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States
| | - Ivana Thompson
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States
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20
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Simmons RG, Baayd J, Elliott S, Cohen SR, Turok DK. Improving access to highly effective emergency contraception: an assessment of barriers and facilitators to integrating the levonorgestrel IUD as emergency contraception using two applications of the Consolidated Framework for Implementation Research. Implement Sci Commun 2022; 3:129. [PMID: 36494859 PMCID: PMC9737706 DOI: 10.1186/s43058-022-00377-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 11/11/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Emergency contraception prevents unwanted pregnancy after sexual intercourse. New evidence has demonstrated that the levonorgestrel 52 mg IUD is a highly effective method of emergency contraception. However, translating this research finding into clinical practice faces existing barriers to IUD access, including costs and provider training, novel barriers of providing IUDs for emergency contraception at unscheduled appointments. The purpose of this study was to identify barriers and facilitators to the utilization of the levonorgestrel IUD as emergency contraception from client, provider, and health systems perspectives. METHODS We conducted English and Spanish-speaking focus groups (n=5) of both contraceptive users (n=22) and providers (n=13) to examine how the levonorgestrel IUD as EC was perceived and understood by these populations and to determine barriers and facilitators of utilization. We used findings from our focus groups to design a high-fidelity in-situ simulation scenario around EC that we pilot tested with clinical teams in three settings (a county health department, a community clinic, and a midwifery clinic), to further explore structural and health systems barriers to care. Simulation scenarios examined health system barriers to the provision of the levonorgestrel IUD as EC. We coded both focus groups and in-clinic simulations using the modified Consolidated Framework for Implementation Research (CFIR). We then applied our findings to the CFIR-Expert Recommendations for Implementing Change (ERIC) Barrier Busting Tool and mapped results to implement recommendations provided by participants. RESULTS Ultimately, 9 constructs from the CFIR were consistently identified across focus groups and simulations. Main barriers included suboptimal knowledge and acceptability of the intervention itself, appropriately addressing knowledge and education needs among both providers and contraceptive clients, and adequately accounting for structural barriers inherent in the health system. The CFIR-ERIC Barrier Busting Tool identified eight strategies to improve levonorgestrel IUD as EC access: identifying implementation champions, conducting educational meetings, preparing educational toolkits, involving patients and their partners in implementation, conducting a local needs assessment, distributing educational materials, and obtaining patient feedback. CONCLUSIONS To sustainably incorporate the levonorgestrel IUD as EC into clinical practice, education, health systems strengthening, and policy changes will be necessary.
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Affiliation(s)
- Rebecca G. Simmons
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132 USA
| | - Jami Baayd
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132 USA
| | - Sarah Elliott
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132 USA
| | - Susanna R. Cohen
- LIFT Simulation Design Lab, Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132 USA
| | - David K. Turok
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132 USA
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21
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Muacevic A, Adler JR, Kulshreshtha A, Zangmo R, Roy KK. Exploring the Role of Levonorgestrel Intrauterine System (LNG-IUS) as a Method of Emergency Contraception (EC). Cureus 2022; 14:e31959. [PMID: 36600871 PMCID: PMC9800030 DOI: 10.7759/cureus.31959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2022] [Indexed: 11/29/2022] Open
Abstract
Copper T 380-A (CuT380A) intrauterine device (IUD) has been an effective method of emergency contraception (EC). Levonorgestrel intrauterine system (LNG-IUS) has not been approved by the Food and Drug Association for EC till now. There are few studies that provide data regarding the efficacy of LNG-IUS as EC. This systematic review tried to explore the efficacy of LNG-IUS in preventing accidental pregnancies up to five days of unprotected intercourse. A systematic review of the published studies on the use of LNG-IUS as EC was done. All randomized trials, prospective cohorts, retrospective cohorts. and case-control study designs pertaining to this topic were included in this review. Abstracts were retrieved and reviewed by two authors independently. Variables pertaining to socio-demographic parameters, EC use-related variables (reason for use, frequency, time elapsed since coitus), and those associated with sexual habits were selected and recorded. A total of six articles were rendered for the review. High school students and those attending college accounted for 36.8%-51.8% of the study population. Data on the reason for seeking EC showed noncompliance to routine contraception as the most common reason, followed by failure of withdrawal method, breach of barrier contraception, and unplanned intercourse. With a negligible failure rate, LNG-IUS seemed to be a good alternative to the existing copper EC. Considering the plethora of noncontraceptive benefits associated, LNG-IUS can be safely provided as an option of EC in the cafeteria approach within five days of unprotected intercourse.
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22
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Al Kindi R, Al Salmani A, Al Hadhrami R, Al Sumri S, Al Sumri H. Perspective Chapter: Modern Birth Control Methods. Stud Fam Plann 2022. [DOI: 10.5772/intechopen.103858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This chapter focuses on various modern birth control methods, including combined oral contraceptives, progestogen-only pills, progestogen-only injectables, progestogen-only implants, intrauterine devices, barrier contraceptives, and emergency contraceptive pills. Each contraceptive method is covered in detail, including mechanism of action, effectiveness, health benefits, advantages, disadvantages, risks, and side-effects.
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23
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Gawron LM, He T, Lewis L, Fudin H, Callegari LS, Turok DK, Stevens V. Oral Emergency Contraception Provision in the Veterans Health Administration: a Retrospective Cohort Study. J Gen Intern Med 2022; 37:685-689. [PMID: 36042074 PMCID: PMC9481759 DOI: 10.1007/s11606-022-07596-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 04/01/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND In the USA, oral emergency contraception (EC) use to prevent unintended pregnancy is increasing. Oral EC methods include levonorgestrel (LNG) and ulipristal acetate (UPA), with increased UPA efficacy over LNG in high BMI users and those beyond 3 days post intercourse. The Veterans Health Administration (VHA) provides oral EC at low or no cost, yet prescription-level Veteran data are lacking. OBJECTIVE To describe oral EC provision in VHA, including method type and Veteran user and prescriber characteristics. DESIGN A retrospective cohort study using VHA administrative data. PARTICIPANTS All VHA oral EC prescriptions from January 1, 2016, to December 31, 2020. MAIN MEASURES We linked Veteran-level sociodemographic and military characteristics and provider-level data with each prescription to identify variables associated with oral EC method. KEY RESULTS A total of 4280 EC prescriptions (85% LNG) occurred for 3120 unique Veterans over 5 years. While prescriptions remained low annually, the proportion of UPA prescriptions increased from 12 to 19%. Compared to LNG users, UPA users were older (34% vs 25% over age 35 years, p <0.001); more likely to identify as white (57% vs 46%) and non-Hispanic (84% vs 79%) (p <0.001); and more likely to have a BMI ≥ 25 (76% vs 67%, p <0.001). UPA prescriptions originated most frequently from VA Medical Centers (87%) and women's health clinics (76%) compared to community-based or other clinic types. In multivariable regression models, race, ethnicity, BMI ≥30, and prescriber facility type of a VA Medical Center or a women's clinic location were predictive of UPA prescription. CONCLUSIONS Oral EC provision in VHA remains low, but UPA use is increasing. LNG prescription occurs frequently in high BMI Veterans who would benefit from increased efficacy of UPA. Interventions to expand oral EC access in VHA are essential to ensure Veterans' ability to avert unwanted pregnancies.
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Affiliation(s)
- Lori M Gawron
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah, 30N 1900E Rm 2B-200, Salt Lake City, UT, 84132, USA. .,VA Salt Lake City Health Care System, Salt Lake City, UT, USA.
| | - Tao He
- VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,Division of Epidemiology Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Lacey Lewis
- VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,Division of Epidemiology Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Hannah Fudin
- VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Lisa S Callegari
- VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - David K Turok
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah, 30N 1900E Rm 2B-200, Salt Lake City, UT, 84132, USA
| | - Vanessa Stevens
- VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,Division of Epidemiology Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
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24
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Lee SC, Norman WV. Emergency contraception subsidy in Canada: a comparative policy analysis. BMC Health Serv Res 2022; 22:1110. [PMID: 36050668 PMCID: PMC9438154 DOI: 10.1186/s12913-022-08416-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 08/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Canada, cost prohibits access to emergency contraception (EC) which may assist to prevent unintended pregnancy. The drug, ulipristal acetate (UPA-EC), is more clinically effective and cost-effective than the prior standard levonorgestrel (LNG-EC). We analyzed provincial EC subsidization policies and examined underlying decision-making processes. METHODS We undertook documentary analysis of provincial EC subsidization policies in publicly available drug formularies. We conducted semi-structured interviews with key informants to explore the processes underlying current policies. RESULTS Quebec is the only province to subsidize UPA-EC, whilst all ten provinces subsidize LNG-EC. As such, provincial EC subsidization policies do not align with the latest UPA-EC evidence. Interviews revealed that evidence was valued in the policymaking process and formulary decisions were made through interdisciplinary consensus. CONCLUSIONS We identify a gap between EC subsidization policies and the latest evidence. Institutional structures affect policies reflecting evolving evidence. Increasing interdisciplinary mechanisms may encourage evidence-based policies.
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Affiliation(s)
- Sabrina C Lee
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.,Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, WN5002-665 William Ave, Winnipeg, MB, R3E 0L8, Canada
| | - Wendy V Norman
- Faculty of Public Health & Policy, London School of Hygiene & Tropical, London, UK. .,Department of Family Practice, University of British Columbia, 320-5950 University Boulevard, Vancouver, BC, V6T 1Z3, Canada.
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Abstract
PURPOSE OF REVIEW This review is intended to provide perspective on the history of selective progesterone receptor modulators (SPRMs) and progesterone antagonists, their current availability, therapeutic promise and safety concerns. RECENT FINDINGS Despite keen interest in synthesis of these compounds, only a handful have had clinical test results allowing for commercialization. Mifepristone is well tolerated and effective for single dose first trimester at-home pregnancy termination and is available in much of the world. Ulipristal acetate, at single doses, is well tolerated and effective for emergency contraception, with less availability. Chronic use of these agents has been associated with abnormal liver enzymes, and rarely, with hepatic failure; causality is not understood. SUMMARY SPRMs and progesterone antagonists have great therapeutic promise for use in other reproductive disorders, including breast cancer, endometriosis, adenomyosis, estrogen-free contraception and cervical ripening but require additional study. Alternative formulations, whether local (topical breast or intrauterine) or extended-release may reduce the incidence of liver function abnormalities and should be explored.
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26
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Ceulemans M, Brughmans M, Poortmans LL, Spreuwers E, Willekens J, Roose N, De Wulf I, Foulon V. Development and Pilot Testing of a Dispensing Protocol on Emergency Contraceptive Pills for Community Pharmacists in Belgium. PHARMACY 2022; 10:pharmacy10030058. [PMID: 35736773 PMCID: PMC9228420 DOI: 10.3390/pharmacy10030058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/23/2022] [Accepted: 05/30/2022] [Indexed: 11/16/2022] Open
Abstract
Community pharmacists in Belgium frequently dispense emergency contraceptive pills (ECPs). However, variable and insufficient counseling practices exist across pharmacies, highlighting the need for standardization and quality improvement strategies. The aim of this project was to develop and test an ECP dispensing protocol for pharmacists. An ‘experience-based’ co-design approach involving academic and practicing pharmacists was applied, followed by a 4-month test period and interviews to assess users’ experiences. In total, eight geographically dispersed pharmacies participated. Pharmacists (n = 15) reached a consensus on most items to be included in the protocol, which was subsequently tested in seven pharmacies, with overall 97 registered ECP conversations. Pharmacists considered the protocol complete but felt that not all items should be mentioned/questioned during all conversations. They suggested only subtle modifications to be made prior to delivering a final protocol ready for nationwide distribution. Despite attributing positive effects to having a protocol, no single pharmacist ‘actively’ used it at-the-counter but used it instead as a ‘checklist’ after the encounter. Pharmacists found that the paper-based format of the protocol hindered protocol-based dispensing. Future research is needed to provide evidence on the actual benefits of protocol application, as well as to identify factors influencing the implementation of ECP dispensing using a software-integrated protocol.
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Affiliation(s)
- Michael Ceulemans
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, 3000 Leuven, Belgium; (N.R.); (V.F.)
- Teratology Information Service, Netherlands Pharmacovigilance Centre Lareb, 5237 MH Hertogenbosch, The Netherlands
- L-C&Y, Child and Youth Institute, KU Leuven, 3000 Leuven, Belgium
- Correspondence: ; Tel.: +32-16-37-72-27
| | - Marieke Brughmans
- Faculty of Pharmaceutical Sciences, KU Leuven, 3000 Leuven, Belgium; (M.B.); (L.-L.P.); (E.S.); (J.W.)
| | - Laura-Lien Poortmans
- Faculty of Pharmaceutical Sciences, KU Leuven, 3000 Leuven, Belgium; (M.B.); (L.-L.P.); (E.S.); (J.W.)
| | - Ellen Spreuwers
- Faculty of Pharmaceutical Sciences, KU Leuven, 3000 Leuven, Belgium; (M.B.); (L.-L.P.); (E.S.); (J.W.)
| | - Julie Willekens
- Faculty of Pharmaceutical Sciences, KU Leuven, 3000 Leuven, Belgium; (M.B.); (L.-L.P.); (E.S.); (J.W.)
| | - Nele Roose
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, 3000 Leuven, Belgium; (N.R.); (V.F.)
| | | | - Veerle Foulon
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, 3000 Leuven, Belgium; (N.R.); (V.F.)
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Chen X, Fernando SR, Lee YL, Yeung WSB, Ng EHY, Li RHW, Lee KF. High-Throughput In Vitro Screening Identified Nemadipine as a Novel Suppressor of Embryo Implantation. Int J Mol Sci 2022; 23:ijms23095073. [PMID: 35563464 PMCID: PMC9103851 DOI: 10.3390/ijms23095073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 04/29/2022] [Accepted: 05/01/2022] [Indexed: 02/01/2023] Open
Abstract
Current contraceptive methods interfere with folliculogenesis, fertilization, and embryo implantation by physical or hormonal approaches. Although hormonal contraceptive pills are effective in regulating egg formation, they are less effective in preventing embryo implantation. To explore the use of non-hormonal compounds that suppress embryo implantation, we established a high-throughput spheroid-endometrial epithelial cell co-culture assay to screen the Library of Pharmacologically Active Compounds (LOPAC) for compounds that affect trophoblastic spheroid (blastocyst surrogate) attachment onto endometrial epithelial Ishikawa cells. We identified 174 out of 1280 LOPAC that significantly suppressed BeWo spheroid attachment onto endometrial Ishikawa cells. Among the top 20 compounds, we found the one with the lowest cytotoxicity in Ishikawa cells, P11B5, which was later identified as Nemadipine-A. Nemadipine-A at 10 µM also suppressed BeWo spheroid attachment onto endometrial epithelial RL95-2 cells and primary human endometrial epithelial cells (hEECs) isolated from LH +7/8-day endometrial biopsies. Mice at 1.5 days post coitum (dpc) treated with a transcervical injection of 100 µg/kg Nemadipine-A or 500 µg/kg PRI-724 (control, Wnt-inhibitor), but not 10 µg/kg Nemadipine-A, suppressed embryo implantation compared with controls. The transcript expressions of endometrial receptivity markers, integrin αV (ITGAV) and mucin 1 (MUC1), but not β-catenin (CTNNB1), were significantly decreased at 2.5 dpc in the uterus of treated mice compared with controls. The reduction of embryo implantation by Nemadipine-A was likely mediated through suppressing endometrial receptivity molecules ITGAV and MUC1. Nemadipine-A is a potential novel non-hormonal compound for contraception.
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Affiliation(s)
- Xian Chen
- Department of Obstetrics and Gynaecology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China; (X.C.); (S.R.F.); (Y.-L.L.); (W.S.-B.Y.); (E.H.-Y.N.); (R.H.-W.L.)
| | - Sudini Ranshaya Fernando
- Department of Obstetrics and Gynaecology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China; (X.C.); (S.R.F.); (Y.-L.L.); (W.S.-B.Y.); (E.H.-Y.N.); (R.H.-W.L.)
- Department of Animal Science, Faculty of Animal Science and Export Agriculture, Uva Wellassa University, Badulla 90000, Sri Lanka
| | - Yin-Lau Lee
- Department of Obstetrics and Gynaecology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China; (X.C.); (S.R.F.); (Y.-L.L.); (W.S.-B.Y.); (E.H.-Y.N.); (R.H.-W.L.)
- Shenzhen Key Laboratory of Fertility Regulation, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518000, China
| | - William Shu-Biu Yeung
- Department of Obstetrics and Gynaecology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China; (X.C.); (S.R.F.); (Y.-L.L.); (W.S.-B.Y.); (E.H.-Y.N.); (R.H.-W.L.)
- Shenzhen Key Laboratory of Fertility Regulation, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518000, China
| | - Ernest Hung-Yu Ng
- Department of Obstetrics and Gynaecology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China; (X.C.); (S.R.F.); (Y.-L.L.); (W.S.-B.Y.); (E.H.-Y.N.); (R.H.-W.L.)
- Shenzhen Key Laboratory of Fertility Regulation, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518000, China
| | - Raymond Hang-Wun Li
- Department of Obstetrics and Gynaecology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China; (X.C.); (S.R.F.); (Y.-L.L.); (W.S.-B.Y.); (E.H.-Y.N.); (R.H.-W.L.)
- Shenzhen Key Laboratory of Fertility Regulation, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518000, China
| | - Kai-Fai Lee
- Department of Obstetrics and Gynaecology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China; (X.C.); (S.R.F.); (Y.-L.L.); (W.S.-B.Y.); (E.H.-Y.N.); (R.H.-W.L.)
- Shenzhen Key Laboratory of Fertility Regulation, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518000, China
- Correspondence: ; Fax: +852-28161947
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O'Neil ML, Aldanmaz B, Althuntaş D. The Availability of Emergency Contraception from Family Health Centers in Turkey. Health Policy 2022; 126:715-721. [DOI: 10.1016/j.healthpol.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 04/02/2022] [Accepted: 04/15/2022] [Indexed: 11/25/2022]
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Westhoff CL, Guo H, Wang Z, Hibshoosh H, Polaneczky M, Pike MC, Ha R. The progesterone-receptor modulator, ulipristal acetate, drastically lowers breast cell proliferation. Breast Cancer Res Treat 2022; 192:321-329. [PMID: 35015210 PMCID: PMC10088437 DOI: 10.1007/s10549-021-06503-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 12/29/2021] [Indexed: 11/02/2022]
Abstract
PURPOSE The proliferation of breast epithelial cells increases during the luteal phase of the menstrual cycle, when they are exposed to progesterone, suggesting that ulipristal acetate, a selective progestin-receptor modulator (SPRM), may reduce breast cell proliferation with potential use in breast cancer chemoprevention. METHODS Women aged 18-39 were randomized 1:1 to ulipristal 10-mg daily or to a combination oral contraceptive (COC) for 84 days. Participants underwent a breast biopsy and breast MRI at baseline and at end of study treatment. Proliferation of breast TDLU cells was evaluated by Ki67 immunohistochemical stain. We evaluated the breast MRIs for background parenchymal enhancement (BPE). All slides and images were masked for outcome evaluation. RESULTS Twenty-eight treatment-compliant participants completed the study; 25 of whom had evaluable Ki67 results at baseline and on-treatment. From baseline to end of treatment, Ki67 % positivity (Ki67%+) decreased a median of 84% in the ulipristal group (N = 13; 2-sided p (2p) = 0.040) versus a median increase of 8% in the COC group (N = 12; 2p = 0.85). Median BPE scores decreased from 3 to 1 in the ulipristal group (p = 0.008) and did not decrease in the COC group. CONCLUSION Ulipristal was associated with a major decrease in Ki67%+ and BPE. Ulipristal would warrant further investigation for breast cancer chemoprevention were it not for concerns about its liver toxicity. Novel SPRMs without liver toxicity could provide a new approach to breast cancer chemoprevention. TRIAL REGISTRATION NCT02922127, 4 October 2016.
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Affiliation(s)
- Carolyn L Westhoff
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, PH 16-69, 630 West 168th Street, New York, NY, 10032, USA.
| | - Hua Guo
- Department of Pathology, Columbia University Irving Medical Center, New York, NY, USA
| | - Zhong Wang
- Department of Pathology, Columbia University Irving Medical Center, New York, NY, USA
| | - Hanina Hibshoosh
- Department of Pathology, Columbia University Irving Medical Center, New York, NY, USA
| | - Margaret Polaneczky
- Department of Obstetrics and Gynecology, Weill-Cornell Medical Center, New York, NY, USA
| | - Malcolm C Pike
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Richard Ha
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA
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Leon-Larios F, Ruiz-Ferron C, Jalon-Neira RM, Praena-Fernández JM. Nursing Students' Knowledge, Awareness, and Experiences of Emergency Contraception Pills' Use. J Clin Med 2022; 11:jcm11020418. [PMID: 35054112 PMCID: PMC8780468 DOI: 10.3390/jcm11020418] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/31/2021] [Accepted: 01/11/2022] [Indexed: 02/04/2023] Open
Abstract
The emergency contraception pill (ECP) is a non-prescribed medication in Spain. However, there is not enough evidence of its use among young people to define sex education contents. The aims of this research were to describe the experiences of the use of the ECP in university students and analyze their knowledge, attitude, and awareness regarding the ECP. The cross-sectional, analytic study was conducted with nursing degree students at the University of Seville. A total of 478 students answered the questionnaire. All of the students (100%) had heard about the ECP and had a positive attitude towards this contraceptive. A total of 25.7% had used the ECP, mainly because a condom had failed or because they did not use any contraceptive at all. Deficiencies in knowledge are related with the ECPs' mechanism of action, efficacy after repeated use, and the type of ECP available. Female students who used no method at all or withdrawal, and who were over 20 years old, used ECP to a greater extent (p < 0.005). Further education initiatives focused on the use of the ECP, its efficacy, and typology are needed, particularly among future health professionals who will later educate other young people.
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Affiliation(s)
- Fatima Leon-Larios
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Seville, Spain; (F.L.-L.); (J.-M.P.-F.)
| | - Cecilia Ruiz-Ferron
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Seville, Spain; (F.L.-L.); (J.-M.P.-F.)
- University Hospital Virgen del Rocío, 41013 Seville, Spain
- Correspondence:
| | | | - Juan-Manuel Praena-Fernández
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Seville, Spain; (F.L.-L.); (J.-M.P.-F.)
- Unit Biostatistic, Department of Statistics, Faculty of Medicine, University of Granada, 18016 Granada, Spain
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Abstract
IMPORTANCE Many women spend a substantial proportion of their lives preventing or planning for pregnancy, and approximately 87% of US women use contraception during their lifetime. OBSERVATIONS Contraceptive effectiveness is determined by a combination of drug or device efficacy, individual fecundability, coital frequency, and user adherence and continuation. In the US, oral contraceptive pills are the most commonly used reversible method of contraception and comprise 21.9% of all contraception in current use. Pregnancy rates of women using oral contraceptives are 4% to 7% per year. Use of long-acting methods, such as intrauterine devices and subdermal implants, has increased substantially, from 6% of all contraceptive users in 2008 to 17.8% in 2016; these methods have failure rates of less than 1% per year. Estrogen-containing methods, such as combined oral contraceptive pills, increase the risk of venous thrombosis from 2 to 10 venous thrombotic events per 10 000 women-years to 7 to 10 venous thrombotic events per 10 000 women-years, whereas progestin-only and nonhormonal methods, such as implants and condoms, are associated with rare serious risks. Hormonal contraceptives can improve medical conditions associated with hormonal changes related to the menstrual cycle, such as acne, endometriosis, and premenstrual dysphoric disorder. Optimal contraceptive selection requires patient and clinician discussion of the patient's tolerance for risk of pregnancy, menstrual bleeding changes, other risks, and personal values and preferences. CONCLUSIONS AND RELEVANCE Oral contraceptive pills are the most commonly used reversible contraceptives, intrauterine devices and subdermal implants have the highest effectiveness, and progestin-only and nonhormonal methods have the lowest risks. Optimal contraceptive selection incorporates patient values and preferences.
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Affiliation(s)
- Stephanie Teal
- Department of OB/GYN, University Hospitals Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - Alison Edelman
- Department of OB/GYN, Oregon Health & Science University, Portland
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Pagano HP, Zapata LB, Curtis KM, Whiteman MK. Changes in U.S. Healthcare Provider Practices Related to Emergency Contraception. Womens Health Issues 2021; 31:560-566. [PMID: 34511322 PMCID: PMC11079952 DOI: 10.1016/j.whi.2021.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 07/22/2021] [Accepted: 07/29/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Emergency contraception (EC), including EC pills (ECPs) and the copper intrauterine device, can prevent pregnancy after sexual encounters in which contraception was not used or used incorrectly. The U.S. Selected Practice Recommendations for Contraceptive Use (U.S. SPR), initially released in 2013, provides evidence-based clinical recommendations on the provision of EC. The objective of this analysis was to assess the percentage of health care providers reporting frequent provision of select EC practices around the time of and after the release of the U.S. SPR. METHODS We conducted two cross-sectional mailed surveys using different nationwide samples of office-based physicians and public-sector providers in 2013 and 2014 (n = 2,060) and 2019 (n = 1,420). We compared the percentage of providers reporting frequent provision of select EC practices by time period, overall, and by provider type. RESULTS In 2019, few providers frequently provided an advance prescription for ECPs (16%), an advance supply of ECPs (7%), or the copper intrauterine device as EC (8%), although 41% frequently provided or prescribed regular contraception at the same time as providing ECPs. Providers in 2019 were more likely than providers in 2013 and 2014 to provide or prescribe contraception at the same time as providing ECPs (adjusted prevalence ratio, 1.26; 95% confidence interval, 1.001-1.59) and to provide a copper intrauterine device as EC (adjusted prevalence ratio, 3.87; 95% confidence interval 2.10-7.15); there were no other significant differences by time period. CONCLUSIONS Few providers report frequent implementation of recommended EC practices. Understanding the barriers faced by providers and clinics in implementing these practices may improve access to EC.
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Affiliation(s)
- H Pamela Pagano
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Lauren B Zapata
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kathryn M Curtis
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Maura K Whiteman
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
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Chan MC, Munro S, Schummers L, Albert A, Mackenzie F, Soon JA, Ragsdale P, Fitzsimmons B, Renner R. Dispensing and practice use patterns, facilitators and barriers for uptake of ulipristal acetate emergency contraception in British Columbia: a mixed-methods study. CMAJ Open 2021; 9:E1097-E1104. [PMID: 34848550 PMCID: PMC8648349 DOI: 10.9778/cmajo.20200193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Ulipristal acetate 30 mg became available as prescription-only emergency contraception in British Columbia, Canada, in September 2015, as an addition to over-the-counter levonorgestrel emergency contraception. In this study, we determined dispensing and practice use patterns for ulipristal acetate, as well as facilitators of and barriers to emergency contraception for physicians, pharmacists and patients in BC. METHODS In the quantitative component of this mixed-methods study, we examined ulipristal acetate use from September 2015 to December 2018 using a database that captures all outpatient prescription dispensations in BC (PharmaNet) and another capturing market sales numbers for all oral emergency contraception in BC (IQVIA). We analyzed the quantitative data descriptively. We conducted semistructured interviews from August to November 2019, exploring barriers and facilitators affecting the use of ulipristal acetate. We performed iterative qualitative data collection and thematic analysis guided by Michie's Theoretical Domains Framework. RESULTS Over the 3-year study period, 318 patients filled 368 prescriptions for ulipristal acetate. Use of this agent increased between 2015 and 2018. However, levonorgestrel use by sales (range 118 897-129 478 units/yr) was substantially higher than use of ulipristal acetate (range 128-389 units/yr). In the 39 interviews we conducted, from the perspectives of 12 patients, 12 community pharmacists, and 15 prescribers, we identified the following themes and respective theoretical domains as barriers to access: low awareness of ulipristal acetate (knowledge), beliefs and experiences related to shame and stigma (beliefs about consequences), and multiple health system barriers (reinforcement). INTERPRETATION Use of ulipristal acetate in BC was low compared with use of levonorgestrel emergency contraception; lack of knowledge, beliefs about consequences and health system barriers may be important impediments to expanding use of ulipristal acetate. These findings illuminate potential factors to explain low use of this agent and point to the need for additional strategies to support implementation.
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Affiliation(s)
- Michelle C Chan
- Department of Obstetrics and Gynaecology (Chan, Munro, Fitzsimmons, Renner), Centre for Health Evaluation and Outcome Sciences (Munro), Department of Family Practice (Schummers, Soon) and Faculty of Pharmaceutical Sciences (Soon, Ragsdale), University of British Columbia; Women's Health Research Institute (Albert, Mackenzie), British Columbia Women's Hospital, Vancouver, BC
| | - Sarah Munro
- Department of Obstetrics and Gynaecology (Chan, Munro, Fitzsimmons, Renner), Centre for Health Evaluation and Outcome Sciences (Munro), Department of Family Practice (Schummers, Soon) and Faculty of Pharmaceutical Sciences (Soon, Ragsdale), University of British Columbia; Women's Health Research Institute (Albert, Mackenzie), British Columbia Women's Hospital, Vancouver, BC
| | - Laura Schummers
- Department of Obstetrics and Gynaecology (Chan, Munro, Fitzsimmons, Renner), Centre for Health Evaluation and Outcome Sciences (Munro), Department of Family Practice (Schummers, Soon) and Faculty of Pharmaceutical Sciences (Soon, Ragsdale), University of British Columbia; Women's Health Research Institute (Albert, Mackenzie), British Columbia Women's Hospital, Vancouver, BC
| | - Arianne Albert
- Department of Obstetrics and Gynaecology (Chan, Munro, Fitzsimmons, Renner), Centre for Health Evaluation and Outcome Sciences (Munro), Department of Family Practice (Schummers, Soon) and Faculty of Pharmaceutical Sciences (Soon, Ragsdale), University of British Columbia; Women's Health Research Institute (Albert, Mackenzie), British Columbia Women's Hospital, Vancouver, BC
| | - Frannie Mackenzie
- Department of Obstetrics and Gynaecology (Chan, Munro, Fitzsimmons, Renner), Centre for Health Evaluation and Outcome Sciences (Munro), Department of Family Practice (Schummers, Soon) and Faculty of Pharmaceutical Sciences (Soon, Ragsdale), University of British Columbia; Women's Health Research Institute (Albert, Mackenzie), British Columbia Women's Hospital, Vancouver, BC
| | - Judith A Soon
- Department of Obstetrics and Gynaecology (Chan, Munro, Fitzsimmons, Renner), Centre for Health Evaluation and Outcome Sciences (Munro), Department of Family Practice (Schummers, Soon) and Faculty of Pharmaceutical Sciences (Soon, Ragsdale), University of British Columbia; Women's Health Research Institute (Albert, Mackenzie), British Columbia Women's Hospital, Vancouver, BC
| | - Parkash Ragsdale
- Department of Obstetrics and Gynaecology (Chan, Munro, Fitzsimmons, Renner), Centre for Health Evaluation and Outcome Sciences (Munro), Department of Family Practice (Schummers, Soon) and Faculty of Pharmaceutical Sciences (Soon, Ragsdale), University of British Columbia; Women's Health Research Institute (Albert, Mackenzie), British Columbia Women's Hospital, Vancouver, BC
| | - Brian Fitzsimmons
- Department of Obstetrics and Gynaecology (Chan, Munro, Fitzsimmons, Renner), Centre for Health Evaluation and Outcome Sciences (Munro), Department of Family Practice (Schummers, Soon) and Faculty of Pharmaceutical Sciences (Soon, Ragsdale), University of British Columbia; Women's Health Research Institute (Albert, Mackenzie), British Columbia Women's Hospital, Vancouver, BC
| | - Regina Renner
- Department of Obstetrics and Gynaecology (Chan, Munro, Fitzsimmons, Renner), Centre for Health Evaluation and Outcome Sciences (Munro), Department of Family Practice (Schummers, Soon) and Faculty of Pharmaceutical Sciences (Soon, Ragsdale), University of British Columbia; Women's Health Research Institute (Albert, Mackenzie), British Columbia Women's Hospital, Vancouver, BC
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Kolanska K, Sbeih M, Canlorbe G, Mekinian A, Varinot J, Capmas P, Koskas M, Aractingi S, Daraï E, Chabbert-Buffet N. Ulipristal Acetate Modifies miRNA Expression in Both Superficial and Basal Layers of the Human Endometrium. J Clin Med 2021; 10:jcm10194442. [PMID: 34640460 PMCID: PMC8509688 DOI: 10.3390/jcm10194442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 12/05/2022] Open
Abstract
(1) Background: Ulipristal acetate (UPA) is a selective progesterone receptor modulator (SPRM) widely used for emergency contraception and mid- to long-term leiomyoma treatment. The aim of this study was to identify modifications of miRNA expression in superficial and basal layers of the human endometrium at the end of the UPA treatment for at least 3 months. (2) Methods: Microarray miRNA analysis of formalin-fixed, paraffin-embedded hysterectomy tissue samples was conducted, followed by an Ingenuity Pathway Analysis. Samples were divided into three groups: women having had 3 months of UPA treatment (n = 7); and two control groups of UPA-naïve women in the proliferative (n = 8) or secretory (n = 6) phase. (3) Results: The UPA modified the expression of 59 miRNAs involved in the processes of cell cycle, carcinogenesis, and inflammation. Their expression profiles were different in the basal and superficial layers. Most of the processes influenced by the UPA in the basal layer were connected to the cell cycle and immune regulation. (4) Conclusion: Specific changes were observed in both layers of the endometrium in the UPA group. However, the miRNA expression in the basal layer was not consistent with that in the superficial layer. Other large studies analysing the long-term impact of SPRM on endometrial miRNA expression are necessary.
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Affiliation(s)
- Kamila Kolanska
- INSERM UMRS 938, Sorbonne Université, Site Saint-Antoine, 27 rue Chaligny, CEDEX 12, 75571 Paris, France; (M.S.); (G.C.); (M.K.); (S.A.); (E.D.); (N.C.-B.)
- Service de Gynécologie Sestertius et Médecine de la Reproduction, AP-HP Sorbonne Université Site Tenon, 4 rue de la Chine, 75020 Paris, France
- Correspondence:
| | - Maria Sbeih
- INSERM UMRS 938, Sorbonne Université, Site Saint-Antoine, 27 rue Chaligny, CEDEX 12, 75571 Paris, France; (M.S.); (G.C.); (M.K.); (S.A.); (E.D.); (N.C.-B.)
| | - Geoffroy Canlorbe
- INSERM UMRS 938, Sorbonne Université, Site Saint-Antoine, 27 rue Chaligny, CEDEX 12, 75571 Paris, France; (M.S.); (G.C.); (M.K.); (S.A.); (E.D.); (N.C.-B.)
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), 75013 Paris, France
| | - Arsène Mekinian
- Service de Médecine Interne, AP-HP Sorbonne Université Site St Antoine, 184 rue du Faubourg Saint Antoine, 75012 Paris, France;
| | - Justine Varinot
- Service d’Anatomopathologie, AP HP Sorbonne Université Site Tenon, 4 rue de la Chine, 75020 Paris, France;
| | - Perrine Capmas
- Department of Gynecology and Obstetrics, University Paris Saclay, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France;
- Inserm, Centre of Research in Epidemiology and Population Health (CESP), U1018, 94276 Le Kremlin-Bicêtre, France
| | - Martin Koskas
- INSERM UMRS 938, Sorbonne Université, Site Saint-Antoine, 27 rue Chaligny, CEDEX 12, 75571 Paris, France; (M.S.); (G.C.); (M.K.); (S.A.); (E.D.); (N.C.-B.)
- Department of Obstetrics and Gynecology, AP-HP Bichat University Hospital, 75018 Paris, France
- Institut de Recherche en Santé de la Femme, Equipe d’accueil 7285, Universite de Versailles Saint-Quentin-en-Yvelines, 78180 Montigny-le-Bretonneux, France
| | - Selim Aractingi
- INSERM UMRS 938, Sorbonne Université, Site Saint-Antoine, 27 rue Chaligny, CEDEX 12, 75571 Paris, France; (M.S.); (G.C.); (M.K.); (S.A.); (E.D.); (N.C.-B.)
| | - Emile Daraï
- INSERM UMRS 938, Sorbonne Université, Site Saint-Antoine, 27 rue Chaligny, CEDEX 12, 75571 Paris, France; (M.S.); (G.C.); (M.K.); (S.A.); (E.D.); (N.C.-B.)
- Service de Gynécologie Sestertius et Médecine de la Reproduction, AP-HP Sorbonne Université Site Tenon, 4 rue de la Chine, 75020 Paris, France
| | - Nathalie Chabbert-Buffet
- INSERM UMRS 938, Sorbonne Université, Site Saint-Antoine, 27 rue Chaligny, CEDEX 12, 75571 Paris, France; (M.S.); (G.C.); (M.K.); (S.A.); (E.D.); (N.C.-B.)
- Service de Gynécologie Sestertius et Médecine de la Reproduction, AP-HP Sorbonne Université Site Tenon, 4 rue de la Chine, 75020 Paris, France
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Kolanska K, Faucher P, Daraï É, Bouchard P, Chabbert-Buffet N. [The history of emergency contraception]. Med Sci (Paris) 2021; 37:779-784. [PMID: 34491186 DOI: 10.1051/medsci/2021116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Emergency contraception (EC) has evolved since the 1960's to enable a better tolerance. Lower hormone doses, simplified schemes, withdrawal of estrogens have led to a user friendly, over-the-counter available EC. The copper intra-uterine device, requiring health care professionals' intervention, is less accessible. However, it allows simultaneous initiation of a reliable long-term contraception. Unfortunately, EC is still underused and information reinforcement is needed to overcome reluctance to its use.
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Affiliation(s)
- Kamila Kolanska
- Service de gynécologie obstétrique et médecine de la reproduction, AP-HP, Sorbonne Université, Hôpital Tenon, 4 rue de la Chine, 75020 Paris, France
| | - Philippe Faucher
- Service de gynécologie- obstétrique, AP-HP, Sorbonne Université, Hôpital Trousseau, 26 avenue du Dr Arnold Netter, Paris, France - Fédération de régulation des naissances de l'Est parisien, AP-HP, Sorbonne Université, Paris, France
| | - Émile Daraï
- Service de gynécologie obstétrique et médecine de la reproduction, AP-HP, Sorbonne Université, Hôpital Tenon, 4 rue de la Chine, 75020 Paris, France
| | - Philippe Bouchard
- Clinique Hartmann, 26 boulevard Victor Hugo, 92200 Neuilly-sur-Seine, France
| | - Nathalie Chabbert-Buffet
- Service de gynécologie obstétrique et médecine de la reproduction, AP-HP, Sorbonne Université, Hôpital Tenon, 4 rue de la Chine, 75020 Paris, France - Service de gynécologie- obstétrique, AP-HP, Sorbonne Université, Hôpital Trousseau, 26 avenue du Dr Arnold Netter, Paris, France - Fédération de régulation des naissances de l'Est parisien, AP-HP, Sorbonne Université, Paris, France
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Jiménez Guerrero M, Fava M, Baccaro LF, Caille AM, Cuasnicú PS, Horcajadas JA, Cohen DJ, Bahamondes L, Cotán D, Munuce MJ. Effect of ulipristal acetate on gene expression profile in endometrial cells in culture and in vivo upon post-ovulatory administration in fertile women. EUR J CONTRACEP REPR 2021; 27:199-207. [PMID: 34486904 DOI: 10.1080/13625187.2021.1975270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To analyse the effect of ulipristal acetate (UPA) as emergency contraception (EC) on the gene expression of human endometrial cell line (HEC-1A) and endometrium from fertile women treated with UPA after ovulation. MATERIALS AND METHODS HEC-1A cells were treated with UPA, and endometrial tissue from four healthy women was collected in cycles before, during and 2 months after post-ovulation pill intake. Ovulation and luteal phase were monitored, and endometrial biopsies were obtained at day LH + 7 in each cycle. In all cases, we analysed the expression profile of 192 genes associated to endometrial receptivity. RESULTS We observed a significant change in total transcriptomic activity of UPA-treated HEC-1A cells compared to controls. In vivo, we also observed a trend to down-regulation of genes in the UPA-treated cycle that was partially restored in the post-treatment cycle. Altogether, our results supported a partially reversible effect of UPA in gene expression associated with uterine receptivity. CONCLUSIONS When UPA was administered after ovulation, it seems to induce a down-regulation of the main genes involved in conditioning the endometrium for implantation. This effect is partially restored two months after pill intake. The action of UPA on the endometrium for users of EC should be further investigated.
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Affiliation(s)
| | - Mariana Fava
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Luiz F Baccaro
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Adriana M Caille
- Laboratorio de Medicina Reproductiva, Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Rosario, Argentina
| | - Patricia S Cuasnicú
- Instituto de Biología y Medicina Experimental (IBYME-CONICET), Buenos Aires, Argentina
| | | | - Débora J Cohen
- Instituto de Biología y Medicina Experimental (IBYME-CONICET), Buenos Aires, Argentina
| | - Luis Bahamondes
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | | | - María José Munuce
- Laboratorio de Medicina Reproductiva, Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Rosario, Argentina
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A Nationwide Mystery Caller Evaluation of Oral Emergency Contraception Practices from German Community Pharmacies: An Observational Study Protocol. Healthcare (Basel) 2021; 9:healthcare9080945. [PMID: 34442082 PMCID: PMC8391881 DOI: 10.3390/healthcare9080945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/04/2021] [Accepted: 07/22/2021] [Indexed: 11/16/2022] Open
Abstract
To prevent unwanted pregnancies, oral emergency contraception (EC) with the active ingredients levonorgestrel (LNG) and ulipristal acetate (UPA) is recommended by the guidelines of the German Federal Chamber of Pharmacists (BAK). In this respect, community pharmacies (CPs) in Germany have a major responsibility for information gathering, selecting the appropriate medicine, availability and pricing, among other things. Therefore, it would be appropriate to conduct a study with the aim of investigating information gathering, a possible recommendation as well as availability and pricing for oral EC in German CPs. A representative nationwide observational study based on the simulated patient methodology (SPM) in the form of covert mystery calls will be conducted in a random sample of German CPs stratified according to the 16 federal states. Each selected CP will be randomly called once successfully by one of six both female and male trained mystery callers (MCs). The MCs will simulate a product-based scenario using the request for oral EC. For quality assurance of the data collection, a second observer accompanying the MC is planned. After all mystery calls have been made, each CP will receive written, pharmacy-specific performance feedback. The only national SPM study on oral EC to date has identified deficits in the provision of self-medication consultations with the help of visits in the CPs studied. International studies suggest that UPA in particular is not always available. Significant price differences could be found analogous to another German study for a different indication.
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Wenzel SG, Zabielski B, Borowski S. Contraceptive Needs Among Women Recently Incarcerated at a Rural Appalachian Jail. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2021; 2:263-272. [PMID: 34318296 PMCID: PMC8310744 DOI: 10.1089/whr.2021.0033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/18/2021] [Indexed: 11/13/2022]
Abstract
Background: Incarceration is associated with negative sexual and reproductive health outcomes. We examined contraceptive needs among women incarcerated at a rural Appalachian jail with emphasis on pregnancy history, recent contraceptive use, and current and near-future contraceptive needs. Materials and Methods: A survey was administered to newly incarcerated women at a jail in Southwest Virginia. It included questions about (1) prior pregnancies; (2) pregnancy intentions, contraceptive use, and sexual activity in the 3 months before jail; (3) unprotected sex in the 5 days before jail; (4) interest in contraceptive education and access during incarceration; and (5) post-release sexual activity, pregnancy, and contraceptive plans. Results: One hundred ninety-three women completed surveys. Analyses focused on the 95 at risk for pregnancy. Fifty-eight percent of prior pregnancies on which women provided intention information were unintended, with 74% of respondents reporting at least 1 such pregnancy. Ninety-four percent of women reported vaginal intercourse during the 3 months before jail. Only 46% of those who did not want to get pregnant reported consistent contraceptive use. Condoms and withdrawal were the most common methods used. Forty percent of women were eligible for emergency contraception (EC). Most (78%) participants anticipated sex with a man within 6 months of release, and most (63%) did not want to become pregnant within a year of release. Almost half (47%) expressed interest in receiving birth control while in jail. Conclusions: Results support the need to offer women EC on incarceration, family planning education during confinement, and effective birth control before release.
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Affiliation(s)
- Sophie G. Wenzel
- Department of Population Health Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia, USA
| | - Barbie Zabielski
- New River Health District, Virginia Department of Health, Christiansburg, Virginia, USA
| | - Shelby Borowski
- Department of Human Development and Family Science, College of Liberal Arts and Human Sciences, Virginia Tech, Blacksburg, Virginia, USA
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BakenRa A, Gero A, Sanders J, Simmons R, Fay K, Turok DK. Pregnancy Risk by Frequency and Timing of Unprotected Intercourse Before Intrauterine Device Placement for Emergency Contraception. Obstet Gynecol 2021; 138:79-84. [PMID: 34259467 PMCID: PMC8216596 DOI: 10.1097/aog.0000000000004433] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/26/2021] [Accepted: 04/01/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess pregnancy risk after intrauterine device (IUD) placement by the number and timing of unprotected intercourse episodes in the prior 14 days. METHODS This was a secondary analysis of a randomized trial that compared the copper T380A IUD and levonorgestrel 52-mg intrauterine system for emergency contraception. At enrollment, participants had a negative urine pregnancy test result and reported the frequency and timing of any unprotected intercourse in the preceding 14 days. We assessed pregnancies 1 month after IUD placement and compared pregnancy risk by single or multiple unprotected intercourse episodes and by timing (5 or fewer days before IUD placement or 6 or more days before). RESULTS Among the 655 participants, one pregnancy occurred in a patient who reported intercourse once 48 hours before IUD placement. Multiple unprotected intercourse episodes were reported by 286 participants (43.7%), and 95 participants (14.4%) reported at least one unprotected intercourse episode 6 or more days before IUD placement. No pregnancies occurred among those with multiple unprotected intercourse episodes (0%, 97.5% CI 0-1.3%) or with any unprotected intercourse episode 6-14 days before IUD placement (0.0%, 97.5% CI 0.0-3.8%). Pregnancy risk difference did not significantly differ by single compared with multiple unprotected intercourse episodes (0.3%, 95% CI -0.3% to 0.8%), nor by unprotected intercourse 5 or fewer days before IUD placement or 6 or more days before (0.2%, 95% CI -0.2% to 0.5%). CONCLUSION With a negative urine pregnancy test result at IUD placement, 1-month pregnancy risk remains low, regardless of frequency or timing of unprotected intercourse in the prior 14 days. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT02175030.
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Affiliation(s)
- Abena BakenRa
- University of California Berkeley School of Public Health, Berkeley, California; and the University of Utah School of Medicine, Salt Lake City, Utah
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Cameron ST, Glasier A, McDaid L, Radley A, Patterson S, Baraitser P, Stephenson J, Gilson R, Battison C, Cowle K, Vadiveloo T, Johnstone A, Morelli A, Goulao B, Forrest M, McDonald A, Norrie J. Provision of the progestogen-only pill by community pharmacies as bridging contraception for women receiving emergency contraception: the Bridge-it RCT. Health Technol Assess 2021; 25:1-92. [PMID: 33949940 DOI: 10.3310/hta25270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Unless women start effective contraception after using emergency contraception, they remain at risk of unintended pregnancy. Most women in the UK obtain emergency contraception from community pharmacies that are unable to provide ongoing contraception (apart from barrier methods which have high failure rates). This means that women need an appointment with a general practitioner or at a sexual and reproductive health clinic. We conducted a pragmatic cluster randomised cohort crossover trial to determine whether or not pharmacist provision of a bridging supply of a progestogen-only pill plus the invitation to attend a sexual and reproductive health clinic resulted in increased subsequent use of effective contraception (hormonal or intrauterine). METHODS Twenty-nine pharmacies in three UK cities recruited women receiving emergency contraception (levonorgestrel). In the intervention, women received a 3-month supply of the progestogen-only pill (75 µg of desogestrel) plus a card that provided rapid access to a local sexual and reproductive health clinic. In the control arm, pharmacists advised women to attend their usual contraceptive provider. The primary outcome was reported use of an effective contraception (hormonal and intrauterine methods) at 4 months. Process evaluation was also conducted to inform any future implementation. RESULTS The study took place December 2017 and June 2019 and recruited 636 women to the intervention (n = 316) and control groups (n = 320). There were no statistically significant differences in demographic characteristics between the groups. Four-month follow-up data were available for 406 participants: 63% (198/315) of the control group and 65% (208/318) of the intervention group. The proportion of participants reporting use of effective contraception was 20.1% greater (95% confidence interval 5.2% to 35.0%) in the intervention group (58.4%, 95% confidence interval 48.6% to 68.2%) than in the control group (40.5%, 95% confidence interval 29.7% to 51.3%) (adjusted for recruitment period, treatment arm and centre; p = 0.011). The proportion of women using effective contraception remained statistically significantly larger, when adjusted for age, current sexual relationship and history of past use of effective contraception, and was robust to the missing data. There were no serious adverse events. CONCLUSION Provision of a bridging supply of the progestogen-only pill with emergency contraception from a pharmacist and the invitation to a sexual and reproductive health clinic resulted in a significant increase in self-reported subsequent use of effective contraception. This simple intervention has the potential to prevent more unintended pregnancies for women after emergency contraception. TRIAL REGISTRATION Current Controlled Trials ISRCTN70616901. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 27. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Sharon T Cameron
- Obstetrics and Gynaecology, University of Edinburgh, Edinburgh, UK.,Sexual and Reproductive Health, NHS Lothian, Edinburgh, UK
| | - Anna Glasier
- Obstetrics and Gynaecology, University of Edinburgh, Edinburgh, UK
| | - Lisa McDaid
- Institute for Social Science Research, The University of Queensland, Brisbane, QLD, Australia.,Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Andrew Radley
- Directorate of Public Health, NHS Tayside, Dundee, UK.,Division of Cardiovascular Medicines and Diabetes, Ninewells Hospital and Medical School, Dundee, UK
| | - Susan Patterson
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Paula Baraitser
- Department of Sexual Health, King's College Hospital NHS Foundation Trust, London, UK
| | - Judith Stephenson
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Richard Gilson
- Institute for Global Health, University College London, London, UK
| | - Claire Battison
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | | | - Anne Johnstone
- Obstetrics and Gynaecology, University of Edinburgh, Edinburgh, UK
| | - Alessandra Morelli
- Department of Sexual Health, King's College Hospital NHS Foundation Trust, London, UK
| | - Beatriz Goulao
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Mark Forrest
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Alison McDonald
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - John Norrie
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
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Lindley KJ, Bairey Merz CN, Davis MB, Madden T, Park K, Bello NA. Contraception and Reproductive Planning for Women With Cardiovascular Disease: JACC Focus Seminar 5/5. J Am Coll Cardiol 2021; 77:1823-1834. [PMID: 33832608 PMCID: PMC8041063 DOI: 10.1016/j.jacc.2021.02.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 12/30/2022]
Abstract
The majority of reproductive-age women with cardiovascular disease are sexually active. Early and accurate counseling by the cardiovascular team regarding disease-specific contraceptive safety and effectiveness is imperative to preventing unplanned pregnancies in this high-risk group of patients. This document, the final of a 5-part series, provides evidence-based recommendations regarding contraceptive options for women with, or at high risk for, cardiovascular disease as well as recommendations regarding pregnancy termination for women at excessive cardiovascular mortality risk due to pregnancy.
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Affiliation(s)
- Kathryn J Lindley
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA.
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Melinda B Davis
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Tessa Madden
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ki Park
- Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Natalie A Bello
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
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Jalanko E, Gyllenberg F, Krstic N, Gissler M, Heikinheimo O. Municipal contraceptive services, socioeconomic status and teenage pregnancy in Finland: a longitudinal study. BMJ Open 2021; 11:e043092. [PMID: 33597141 PMCID: PMC7893665 DOI: 10.1136/bmjopen-2020-043092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Declining teenage pregnancy rates have been linked to improved access to youth-friendly contraceptive services, but information on the combined association of these services and socioeconomic factors with teenage pregnancy is lacking. DESIGN AND SETTING This retrospective longitudinal register-based study covers the annual teenage childbirth and induced abortion rates in the 100 largest municipalities in Finland in 2000-2018. We investigated the combined association of regional, socioeconomic (ie, education level and need for social assistance) and adolescent contraceptive service variables (ie, free-of-charge contraception, an adolescent-only clinic and availability of over-the-counter emergency contraception (OTC EC)) with teenage childbirth and induced abortion rates at the municipality level by using Poisson mixed-effects model. PRIMARY OUTCOME MEASURES Annual teenage childbirth and induced abortion rates as numbers per 1000 teenage girls aged 15-19 years old in the 100 largest municipalities in Finland from 2000 to 2018. RESULTS The following variables were significantly associated with both lower teenage childbirth and induced abortion rates when adjusted for all the other variables used in the model: providing free-of-charge contraception (rate ratio (RR) 0.82 (95% CI 0.73 to 0.92) and RR 0.87 (95% CI 0.79 to 0.96), respectively), availability of OTC EC without age limit (RR 0.70 (95% CI 0.67 to 0.75) and RR 0.74 (95% CI 0.71 to 0.78), respectively), and high education level of the municipality (RR 0.94 (95% CI 0.94 to 0.95) and RR 0.94 (95% CI 0.93 to 0.94), respectively). CONCLUSION Providing free-of-charge contraception and availability of OTC EC without age limit are associated with lower teenage pregnancy rates. These services combined with proper counselling are thus important contents of youth-friendly contraceptive services that should be provided equally for all teenagers in order to further reduce teenage pregnancy rates.
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Affiliation(s)
- Eerika Jalanko
- Obstetrics and Gynecology, Naistenklinikka, Helsinki, Finland
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Frida Gyllenberg
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
- City of Vantaa, Division of Health Care and Social Services, Vantaa, Finland
| | - Nikolas Krstic
- The University of British Columbia, Vancouver, British Columbia, Canada
| | - Mika Gissler
- Information, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Oskari Heikinheimo
- Obstetrics and Gynecology, Naistenklinikka, Helsinki, Finland
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
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McAvey B, Kuokkanen S, Zhu L, Pollard JW. The selective progesterone receptor modulator, telapristone acetate, is a mixed antagonist/agonist in the human and mouse endometrium and inhibits pregnancy in mice. F&S SCIENCE 2021; 2:59-70. [PMID: 35559765 DOI: 10.1016/j.xfss.2021.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 12/30/2020] [Accepted: 01/08/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To investigate the effect of the selective progesterone receptor modulator, telapristone acetate (CDB-4124), on endometrial biology and reproductive outcomes. Ovariectomized and hormone-treated CD1 female mice, CD1 female mice with xenotransplants of reconstructed human endometrial tissue, mated wildtype female mice, and cultured human endometrial stromal cells (hESCs) were treated with CDB-4124, followed by the assessment of endometrial cell deoxyribonucleic acid (DNA) proliferation, stromal decidual response, and embryo implantation. DESIGN Experimental study. SETTING Academic research laboratory. PATIENTS Healthy volunteer women from the community were recruited for endometrial biopsies. ANIMALS CD1 out-bred mice (Charles River Laboratories) and nude mice, NU/J (Jackson Laboratories, Bar Harbor, ME). INTERVENTION Treatment of mice and hESCs with CDB-4124. MAIN OUTCOME MEASURE The effect of CDB-4124 on endometrial cell morphology and DNA synthesis, decidual response, and mouse embryo implantation. RESULTS CDB-4124 inhibited estradiol-induced epithelial DNA synthesis in the mouse uterus and xenotransplanted human endometrium. This antiproliferative effect was less than that of progesterone (P4) and was observed when CDB-4124 was administered alone or concomitantly with P4. In the uterine epithelium, CDB-4124 acted as a P4 agonist and partial antagonist. In contrast, CDB-4124 acted as a complete P4 antagonist in the uterine stroma, where it blocked P4's action to induce a decidual response in the pseudopregnant mouse uterus and wildtype mouse uterus after copulation. In mated female mice, CDB-4124 impaired embryo implantation. Similarly, CDB-4124 inhibited the morphological and biochemical transformations of hESCs to decidual cells in vitro. CONCLUSION CDB-4124 exerts mixed P4 antagonistic/agonistic effects in the human and mouse endometrium, which result in failed embryo implantation because of the absence of stromal decidualization.
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Affiliation(s)
- Beth McAvey
- Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York; Ichan School of Medicine, RMA, New York
| | - Satu Kuokkanen
- Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York; NYU Langone Reproductive Specialists of NY, NYU Langone School of Medicine, NYU Langone Long Island School of Medicine, Mineola, New York
| | - Liyin Zhu
- Department of Developmental & Molecular Biology, Albert Einstein College of Medicine, Bronx, New York
| | - Jeffrey W Pollard
- Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York; Medical Research Council Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburg, Edinburgh, United Kingdom.
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Turok DK, Gero A, Simmons RG, Kaiser JE, Stoddard GJ, Sexsmith CD, Gawron LM, Sanders JN. Levonorgestrel vs. Copper Intrauterine Devices for Emergency Contraception. N Engl J Med 2021; 384:335-344. [PMID: 33503342 PMCID: PMC7983017 DOI: 10.1056/nejmoa2022141] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND In the United States, more intrauterine device (IUD) users select levonorgestrel IUDs than copper IUDs for long-term contraception. Currently, clinicians offer only copper IUDs for emergency contraception because data are lacking on the efficacy of the levonorgestrel IUD for this purpose. METHODS This randomized noninferiority trial, in which participants were unaware of the group assignments, was conducted at six clinics in Utah and included women who sought emergency contraception after at least one episode of unprotected intercourse within 5 days before presentation and agreed to placement of an IUD. We randomly assigned participants in a 1:1 ratio to receive a levonorgestrel 52-mg IUD or a copper T380A IUD. The primary outcome was a positive urine pregnancy test 1 month after IUD insertion. When a 1-month urine pregnancy test was unavailable, we used survey and health record data to determine pregnancy status. The prespecified noninferiority margin was 2.5 percentage points. RESULTS Among the 355 participants randomly assigned to receive levonorgestrel IUDs and 356 assigned to receive copper IUDs, 317 and 321, respectively, received the interventions and provided 1-month outcome data. Of these, 290 in the levonorgestrel group and 300 in the copper IUD group had a 1-month urine pregnancy test. In the modified intention-to-treat and per-protocol analyses, pregnancy rates were 1 in 317 (0.3%; 95% confidence interval [CI], 0.01 to 1.7) in the levonorgestrel group and 0 in 321 (0%; 95% CI, 0 to 1.1) in the copper IUD group; the between-group absolute difference in both analyses was 0.3 percentage points (95% CI, -0.9 to 1.8), consistent with the noninferiority of the levonorgestrel IUD to the copper IUD. Adverse events resulting in participants seeking medical care in the first month after IUD placement occurred in 5.2% of participants in the levonorgestrel IUD group and 4.9% of those in the copper IUD group. CONCLUSIONS The levonorgestrel IUD was noninferior to the copper IUD for emergency contraception. (Supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and others; ClinicalTrials.gov number, NCT02175030.).
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Affiliation(s)
- David K Turok
- From the Division of Family Planning, Department of Obstetrics and Gynecology (D.K.T., A.G., R.G.S., J.E.K., C.D.S., L.M.G., J.N.S.), and the Division of Epidemiology, Department of Internal Medicine (G.J.S.), University of Utah, Salt Lake City
| | - Alexandra Gero
- From the Division of Family Planning, Department of Obstetrics and Gynecology (D.K.T., A.G., R.G.S., J.E.K., C.D.S., L.M.G., J.N.S.), and the Division of Epidemiology, Department of Internal Medicine (G.J.S.), University of Utah, Salt Lake City
| | - Rebecca G Simmons
- From the Division of Family Planning, Department of Obstetrics and Gynecology (D.K.T., A.G., R.G.S., J.E.K., C.D.S., L.M.G., J.N.S.), and the Division of Epidemiology, Department of Internal Medicine (G.J.S.), University of Utah, Salt Lake City
| | - Jennifer E Kaiser
- From the Division of Family Planning, Department of Obstetrics and Gynecology (D.K.T., A.G., R.G.S., J.E.K., C.D.S., L.M.G., J.N.S.), and the Division of Epidemiology, Department of Internal Medicine (G.J.S.), University of Utah, Salt Lake City
| | - Gregory J Stoddard
- From the Division of Family Planning, Department of Obstetrics and Gynecology (D.K.T., A.G., R.G.S., J.E.K., C.D.S., L.M.G., J.N.S.), and the Division of Epidemiology, Department of Internal Medicine (G.J.S.), University of Utah, Salt Lake City
| | - Corinne D Sexsmith
- From the Division of Family Planning, Department of Obstetrics and Gynecology (D.K.T., A.G., R.G.S., J.E.K., C.D.S., L.M.G., J.N.S.), and the Division of Epidemiology, Department of Internal Medicine (G.J.S.), University of Utah, Salt Lake City
| | - Lori M Gawron
- From the Division of Family Planning, Department of Obstetrics and Gynecology (D.K.T., A.G., R.G.S., J.E.K., C.D.S., L.M.G., J.N.S.), and the Division of Epidemiology, Department of Internal Medicine (G.J.S.), University of Utah, Salt Lake City
| | - Jessica N Sanders
- From the Division of Family Planning, Department of Obstetrics and Gynecology (D.K.T., A.G., R.G.S., J.E.K., C.D.S., L.M.G., J.N.S.), and the Division of Epidemiology, Department of Internal Medicine (G.J.S.), University of Utah, Salt Lake City
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Williams BN, Jauk VC, Szychowski JM, Arbuckle JL. Adolescent emergency contraception usage, knowledge, and perception. Contraception 2021; 103:361-366. [PMID: 33453186 DOI: 10.1016/j.contraception.2021.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 12/29/2020] [Accepted: 01/10/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We sought to describe the current usage patterns, knowledge regarding, and perception of emergency contraception in adolescent patients. STUDY DESIGN We surveyed female patients ages 14 to 21 seen at the Pediatric and Gynecology Clinic regarding emergency contraception. We posed questions to understand adolescent awareness, personal usage, and means of obtaining emergency contraception. We also explored respondent knowledge of emergency contraception and potential barriers to access. RESULTS Of 261 patients approached, 253 completed the survey with a mean age of 16.7 ± 1.7 years. The majority of respondents (80.2%) had heard of oral emergency contraceptive pills. Among sexually active adolescents, 25.6 % reported personal use. Older adolescents (≥18 years) were more likely to have heard of emergency contraceptive pills, to know someone who used them, and to have used it themselves compared to younger adolescents (all p < 0.05). A minority of respondents knew that emergency contraception could be bought over the counter regardless of age or gender (44.3%) and that parental consent is not required (27.7%). Having ever been sexually active was associated with an increased odds of being correct with regards to the availability and timing of LNG EC. A history of LNG EC use was associated with an increased likelihood of understanding the mechanism of action and side effects of LNG EC. CONCLUSIONS Though adolescents in our population were aware of emergency contraception, only a small portion had used it themselves. Misunderstandings regarding the availability and safety of emergency contraception were common in our population. IMPLICATIONS Educating adolescents on the availability, safety, and mechanism of action of LNG EC may improve utilization of LNG EC in this population.
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Affiliation(s)
| | - Victoria C Jauk
- Department of Obstetrics and Gynecology, University of Alabama School of Medicine, Birmingham, AL, United States
| | - Jeff M Szychowski
- University of Alabama School of Public Health, Birmingham, AL, United States
| | - Janeen L Arbuckle
- Division of Women's Reproductive Health, Department of Obstetrics and Gynecology, University of Alabama School of Medicine, Birmingham, AL, United States.
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Chalati W, Crilly P, Fletcher J, Kayyali R. A Comparative Study of the Cost and Uptake of Community Pharmacy "Stop Smoking and Emergency Contraception" Services from the Perspective of the National Health Service. J Res Pharm Pract 2020; 9:73-87. [PMID: 33102381 PMCID: PMC7547741 DOI: 10.4103/jrpp.jrpp_20_35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 03/21/2020] [Indexed: 11/08/2022] Open
Abstract
Objective: The objective was to explore if the community pharmacy (CP) stop smoking service (SSS) and emergency hormonal contraception patient group direction (EHC PGD) meet the needs of the English population and are cost-effective. Methods: This research was completed over 2 years. Public health resources provided details of CPs and provision of SSS and EHC PGD. Questionnaires were sent to smoking cessation/sexual health leads in local authorities to obtain information not available elsewhere. Questionnaires inquired about CP payment for provision of SSS and EHC PGD, overhead costs, successful outcomes, and validation methods. Quit rates at 4-weeks, 52-weeks, and lifetime determined SSS effectiveness. The effectiveness of EHC PGD was based on the probability of unintended pregnancy with/without levonorgestrel. Incremental cost-effectiveness ratio and cost of quality-adjusted life years (QALYs) gained were calculated. Descriptive statistics were determined. A priori of less than 0.05 (P < 0.05) was significant. Findings: SSS provision and uptake did not match local needs (smoking prevalence) even though increased CP SSS provision correlated with increased SSS success. Similarly, the need (based on teenage pregnancy rates) for EHC PGD did not correlate with the rate of CP provision but only with the uptake. Nevertheless, the provision of SSS and EHC PGD from CPs was cost-effective from an NHS perspective. Various assumptions were tested, but in all cases fell well below NICE QALY recommendations for cost-effectiveness. Conclusion: Provision of SSS and EHC PGD from CP does not meet the needs of the population even though the delivery of these services is cost-effective.
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Affiliation(s)
- Wail Chalati
- Department of Pharmacy, School of Life Sciences, Pharmacy and Chemistry, Kingston University, Kingston, United Kingdom
| | - Philip Crilly
- Department of Pharmacy, School of Life Sciences, Pharmacy and Chemistry, Kingston University, Kingston, United Kingdom
| | - John Fletcher
- Department of Pharmacy, School of Life Sciences, Pharmacy and Chemistry, Kingston University, Kingston, United Kingdom
| | - Reem Kayyali
- Department of Pharmacy, School of Life Sciences, Pharmacy and Chemistry, Kingston University, Kingston, United Kingdom
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Islam MS, Afrin S, Jones SI, Segars J. Selective Progesterone Receptor Modulators-Mechanisms and Therapeutic Utility. Endocr Rev 2020; 41:5828992. [PMID: 32365199 PMCID: PMC8659360 DOI: 10.1210/endrev/bnaa012] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 04/30/2020] [Indexed: 02/07/2023]
Abstract
Selective progesterone receptor modulators (SPRMs) are a new class of compounds developed to target the progesterone receptor (PR) with a mix of agonist and antagonist properties. These compounds have been introduced for the treatment of several gynecological conditions based on the critical role of progesterone in reproduction and reproductive tissues. In patients with uterine fibroids, mifepristone and ulipristal acetate have consistently demonstrated efficacy, and vilaprisan is currently under investigation, while studies of asoprisnil and telapristone were halted for safety concerns. Mifepristone demonstrated utility for the management of endometriosis, while data are limited regarding the efficacy of asoprisnil, ulipristal acetate, telapristone, and vilaprisan for this condition. Currently, none of the SPRMs have shown therapeutic success in treating endometrial cancer. Multiple SPRMs have been assessed for efficacy in treating PR-positive recurrent breast cancer, with in vivo studies suggesting a benefit of mifepristone, and multiple in vitro models suggesting the efficacy of ulipristal acetate and telapristone. Mifepristone, ulipristal acetate, vilaprisan, and asoprisnil effectively treated heavy menstrual bleeding (HBM) in patients with uterine fibroids, but limited data exist regarding the efficacy of SPRMs for HMB outside this context. A notable class effect of SPRMs are benign, PR modulator-associated endometrial changes (PAECs) due to the actions of the compounds on the endometrium. Both mifepristone and ulipristal acetate are effective for emergency contraception, and mifepristone was approved by the US Food and Drug Administration (FDA) in 2012 for the treatment of Cushing's syndrome due to its additional antiglucocorticoid effect. Based on current evidence, SPRMs show considerable promise for treatment of several gynecologic conditions.
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Affiliation(s)
- Md Soriful Islam
- Department of Gynecology and Obstetrics, Division of Reproductive Sciences & Women's Health Research, Johns Hopkins Medicine, Baltimore, Maryland
| | - Sadia Afrin
- Department of Gynecology and Obstetrics, Division of Reproductive Sciences & Women's Health Research, Johns Hopkins Medicine, Baltimore, Maryland
| | - Sara Isabel Jones
- Department of Gynecology and Obstetrics, Division of Reproductive Sciences & Women's Health Research, Johns Hopkins Medicine, Baltimore, Maryland
| | - James Segars
- Department of Gynecology and Obstetrics, Division of Reproductive Sciences & Women's Health Research, Johns Hopkins Medicine, Baltimore, Maryland
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Peng C, Zhao S, Tang L, Wang K, Wang Y, Ding L. A simplified and reliable LC–tandem mass spectrometry method for determination of ulipristal acetate in human plasma and its application to a pharmacokinetic study in healthy Chinese volunteers. Biomed Chromatogr 2020; 34:e4908. [DOI: 10.1002/bmc.4908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 05/21/2020] [Accepted: 05/25/2020] [Indexed: 11/12/2022]
Affiliation(s)
- Chun Peng
- College of Pharmacy and Chemistry Dali University Dali China
- Nanjing Clinical Tech. Laboratories Inc Nanjing China
| | - Shunbo Zhao
- Nanjing Clinical Tech. Laboratories Inc Nanjing China
| | - Ling Tang
- College of Pharmacy and Chemistry Dali University Dali China
- Nanjing Clinical Tech. Laboratories Inc Nanjing China
| | - Keli Wang
- Nanjing Clinical Tech. Laboratories Inc Nanjing China
| | - Yan Wang
- College of Pharmacy and Chemistry Dali University Dali China
| | - Li Ding
- Department of Pharmaceutical Analysis China Pharmaceutical University Nanjing China
- Nanjing Clinical Tech. Laboratories Inc Nanjing China
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Langer B, Grimm S, Lungfiel G, Mandlmeier F, Wenig V. The Quality of Counselling for Oral Emergency Contraceptive Pills-A Simulated Patient Study in German Community Pharmacies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186720. [PMID: 32942744 PMCID: PMC7559115 DOI: 10.3390/ijerph17186720] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 12/23/2022]
Abstract
Background: In Germany, there are two different active substances, levonorgestrel (LNG) and ulipristal acetate (UPA), available as emergency contraception (the “morning after pill”) with UPA still effective even 72 to 120 h after unprotected sexual intercourse, unlike LNG. Emergency contraceptive pills have been available without a medical prescription since March 2015 but are still only dispensed by community pharmacies. The aim of this study was to determine the counselling and dispensing behaviour of pharmacy staff and the factors that may influence this behaviour in a scenario that intends that only the emergency contraceptive pill containing the active substance UPA is dispensed (appropriate outcome). Methods: A cross-sectional study was carried out in the form of a covert simulated patient study in a random sample of community pharmacies stratified by location in the German state of Mecklenburg-Vorpommern and reported in accordance with the STROBE statement. Each pharmacy was visited once at random by one of four trained test buyers. They simulated a product-based request for an emergency contraceptive pill, stating contraceptive failure 3.5 days prior as the reason. The test scenario and the evaluation forms are based on the recommended actions, including the checklist from the Federal Chamber of Pharmacies. Results: All 199 planned pharmacy visits were carried out. The appropriate outcome (dispensing of UPA) was achieved in 78.9% of the test purchases (157/199). A significant correlation was identified between the use of the counselling room and the use of a checklist (p < 0.001). The use of a checklist led to a significantly higher questioning score (p < 0.001). In a multivariate binary logistic regression analysis, a higher questioning score (adjusted odds ratio [AOR] = 1.41; 95% CI = 1.22–1.63; p < 0.001) and a time between 12:01 and 4:00 p.m. (AOR = 2.54; 95% CI = 1.13–5.73; p = 0.024) compared to 8:00 to 12:00 a.m. were significantly associated with achieving the appropriate outcome. Conclusions: In a little over one-fifth of all test purchases, the required dispensing of UPA did not occur. The use of a counselling room and a checklist, the use of a checklist and the questioning score as well as the questioning score and achieving the appropriate outcome are all significantly correlated. A target regulation for the use of a counselling room, an explicit guideline recommendation about the use of a checklist, an obligation for keeping UPA in stock and appropriate mandatory continuing education programmes should be considered.
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A Systematic Review and Meta-analysis of the Adverse Effects of Levonorgestrel Emergency Oral Contraceptive. Clin Drug Investig 2020; 40:395-420. [PMID: 32162237 DOI: 10.1007/s40261-020-00901-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION The levonorgestrel oral emergency contraceptive is well tolerated and effective, however its use is still limited, mainly due to safety concerns. OBJECTIVE This systematic review and meta-analysis aimed to summarize current evidence regarding the adverse events, and their prevalence, reported during the use of oral levonorgestrel emergency contraceptives. METHODS Four electronic databases and the US FDA Adverse Event Reporting System (FAERS) Public Dashboard were searched. Studies that reported or investigated safety outcomes or adverse reactions during the use of levonorgestrel as an emergency oral contraceptive were included. Data on study design, demographics of levonorgestrel and the control cohort, and reported adverse effects were extracted. RESULTS A total of 47 articles were included in this systematic review, from which it was shown that most of the adverse reactions were common and not serious. Uncommon adverse reactions identified included anorexia, ectopic pregnancy, exanthema, chloasma, miscarriage, and weight gain. Multiple serious adverse events, including convulsion, ectopic pregnancy, febrile neutropenia, stroke, abdominal hernia, anaphylaxis, cancer, ovarian cyst rupture, serious infections, and suicidal ideation, were reported. In addition, the prevalence of adverse events after a levonorgestrel 0.75 mg two-dose regimen and a levonorgestrel 1.5 mg single-dose regimen were not statistically different (p > 0.05). CONCLUSIONS The most common adverse effects of levonorgestrel were not serious. This systematic review shows that data regarding the adverse reactions of repeated use of levonorgestrel are scarce. Studies on the multiple uses of levonorgestrel emergency contraception are still required to ensure its safety.
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